Remote Medicaid Benefits Advisor

State of Washington; Olympia (WA); Remote; USD 65,000 - 90,000; Full time

Job summary

State of Washington's Health Care Authority is seeking a Health Benefits Specialist 3 to support Apple Health (Medicaid) clients in a call center environment. You will explain benefits, assist with enrollment in managed care plans, resolve complex inquiries, and coordinate with providers and CSOs to ensure accurate, timely service.

The role emphasizes equity, professional communication, and independent analysis.

Qualifications

• Ability to interpret and apply federal and state laws, rules, policies and program requirements related to medical assistance.
• Ability to independently research, analyze, and evaluate complex information to make determinations.
• Ability to provide accurate technical information and consultation to customers, providers, and stakeholders.
• Strong written and verbal communication to individuals with varying levels of program knowledge.
• Work independently to ensure accuracy, timeliness, and compliance with policies.
• Prioritize and manage complex tasks with limited supervision.

Responsibilities

• Provides expert consultation to clients, providers, MCOs, CSOs, and stakeholders regarding Apple Health benefits in a call center environment.
• Counsels customers on HCA policies, scope of care, rights and responsibilities, and medical assistance procedures.
• Tactfully manages difficult situations and delivers quality customer service.
• Coordinates referrals, eligibility information, and plan membership data between plans, CSOs, and providers.
• Assists customers in resolving disputes and issues related to benefits or plans.
• Resolves complex questions about eligibility, enrollment, and access to services.
• Analyzes and assists with claims submission for medical and social service providers.
• Maintains knowledge of ProviderOne (P1), ACES, POS, TMS, Siebel, and HealthPlanFinder systems.

Skills

Medical Assistance Program Knowledge

Independent Analysis

Customer Consultation

Professional Communication

Quality and Compliance

Workload Management

Education

Bachelor's degree + 1 year experience

Associate degree + 3 years experience

Five years of related experience

One year as Medical Assistance Specialist 2

Tools

ACES

ProviderOne (P1)

Siebel

Job description

State of Washington's Health Care Authority is seeking a Health Benefits Specialist 3 to support Apple Health (Medicaid) clients in a call center environment. You will explain benefits, assist with enrollment in managed care plans, resolve complex inquiries, and coordinate with providers and CSOs to ensure accurate, timely service.

The role emphasizes equity, professional communication, and independent analysis.