SPECIAL PROGRAMS ELIGIBILITY SPECIALIST - 10132026-81678

State of Tennessee

Nashville (TN)

Hybrid

USD 43,000 - 45,000

Full time

21 hours ago

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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 Job Information

Opening Date/Time 10/13/2026 12:00AM Central Time

Job Information

Opening Date/Time 10/13/2026 12:00AM Central Time

Closing Date/Time 10/26/2026 11:59PM Central Time

Salary (Monthly) $3,667.00

Salary (Annually) $44,004.00

Job Type Full-Time

City, State Location Nashville, TN

Department TennCare

LOCATION OF (1) POSITION(S) TO BE FILLED: DIVISION OF TENNCARE, DAVIDSON COUNTY

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position

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.

Substitution of Experience for Education:

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 may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).

Substitution of Experience for Education:

Two years of full-time work as a Managed Care Specialist with the State of Tennessee.

Necessary Special Qualifications:

A valid motor vehicle operator's license may be required.

Overview

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

Under general supervision, is responsible for highly technical professional TennCare program work of considerable difficulty and/or supervisory work of average difficulty; and performs related work as required. This is the highly technical professional or supervisory class in the Managed Care Specialist sub-series. An employee in this class performs highly technical TennCare program work or supervises a small to moderate sized unit of Managed Care Specialists and/or sub professional staff performing TennCare duties. This class differs from Managed Care Specialist 2 in that an incumbent of the latter performs TennCare program work of average difficulty and is not responsible for highly technical or supervisory work.

Responsibilities

Determining Eligibility:

Responsible for reviewing individual applicant applications (i.e.: Breast and Cervical Cancer, Former Foster Care, Children leaving Foster Care, and Emergency Medical Services and enrollee income, resources and other technical elements
Register applications as needed
Process Special Programs related eligibility tasks. This includes priority task from DCS i.e.: Children entering foster care
Monitor queues and production
Process reports to maintain accurate member caseloads
Trouble shoot and respond to inquiries regarding member eligibility.
Demonstrate strong customer service skills, interpretation of public policy, and problem solving
Use proprietary computer-based systems to perform work duties
Respond to emails, telephone calls, and other correspondence in a timely fashion
Customer Service/Time Management
Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base. This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues
Be adept at dealing with ambiguity
Manage time and attendance
Prioritize tasks
Make corrections on cases that have identified errors and perform case reviews as needed to provide additional to management and other stakeholders
Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training
Exercise professional judgment to know when to elevate a concern or issue
Communication
Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.
Attend Staff meetings with peers and one on one meetings with superiors
Ensure accurate and clear communications
Explain eligibility for benefits and services
Interpret policy and procedure in relation to the enrollee's circumstances to ensure the member or applicant's understanding
Communicate the enrollee/applicant's responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant's understanding.
Training
Mentor new and less experienced employees/staff/co-workers to ensure understanding of information/processes, as required.
Conducts or leads in training as required to ensure continual learning and current knowledge related to the managed care field.
Strive to improve professional skills and knowledge through continuous learning to better support peers and customers.