Health Eligibility Program Specialist — Hybrid Work

State of Tennessee; Nashville (TN); Hybrid; USD 43,000 - 45,000; Full time

Job summary

State of Tennessee in Nashville seeks a highly technical and customer-focused Eligibility Specialist within TennCare. The role requires evaluating applicant data, applying complex rules, and coordinating with internal and external stakeholders to determine benefits eligibility.

Hybrid work is available, with a mix of home and office duties; the position emphasizes accuracy, policy knowledge, and collaborative problem solving across programs.

Qualifications

• Education and Experience: Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.

Responsibilities

• Determine Eligibility: review applicant applications (e.g., Breast and Cervical Cancer, Former Foster Care, Children leaving Foster Care, EMS and enrollee income) and qualifications.
• Register applications as needed and process special programs related eligibility tasks.
• Monitor queues and production; process reports to maintain accurate member caseloads.
• Respond to emails, calls, and correspondence; demonstrate strong customer service and policy interpretation.
• Use proprietary computer-based systems to perform duties; communicate clearly with stakeholders.
• Manage time, attendance, and priorities; train and mentor staff as required.
• Explain eligibility for benefits and services and ensure applicant understanding.

Skills

Customer service

Data entry

Policy interpretation

Administrative tasks

Education

Bachelor's degree

Associate's degree + 2 years experience

2 years managed care experience

Tools

Proprietary systems

Job description

State of Tennessee in Nashville seeks a highly technical and customer-focused Eligibility Specialist within TennCare. The role requires evaluating applicant data, applying complex rules, and coordinating with internal and external stakeholders to determine benefits eligibility.

Hybrid work is available, with a mix of home and office duties; the position emphasizes accuracy, policy knowledge, and collaborative problem solving across programs.