Waiver Programs Eligibility Specialist — Hybrid Role

State of Tennessee; Nashville (TN); Hybrid; USD 37,000 - 45,000; Full time

Job summary

State of Tennessee in Nashville is seeking a highly skilled Managed Care Specialist for TennCare. Under general supervision, you will perform highly technical TennCare program work, review applications, determine eligibility, and support enrollment.

You will mentor staff, use proprietary systems, handle inquiries, and coordinate with vendors and internal teams to ensure accurate benefits eligibility and timely service. A hybrid work arrangement is available.

Qualifications

• Bachelor's degree or Associate's degree with two years of qualifying professional experience in administrative, customer service and/or data entry positions related to policy, eligibility within health or healthcare, casework, or insurance settings.
• Experience substitution: up to four years of qualifying work may substitute for the required education.
• Two years of full-time work as a Managed Care Specialist with the State of Tennessee.
• A valid motor vehicle operator's license may be required.

Responsibilities

• Determining Eligibility
• Reviewing individual applicant applications and enrollee income, resources and other technical elements
• Register applications as needed
• Make changes to member eligibility, establish eligibility
• 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 with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base
• Be adept at dealing with ambiguity
• Manage time and prioritize tasks
• Ask for guidance and training as needed
• Strive to improve professional skills through continuous learning
• Exercise professional judgment to know when to elevate concerns
• Communication
• Remain up to date on new policies and procedures
• Explain eligibility for benefits and services
• Interpret policy to ensure understanding
• Explain enrollee responsibilities clearly
• Training: mentor staff and conduct required training
• Continually learn to better support peers and customers.

Skills

Active Learning and Listening

Complex Problem Solving

Judgment and Decision MakingMonitoring

Time Management

Education

Bachelor's or Associate's degree with related experience

Tools

Personal Computer

Telephone

Fax Machine

Printer

Job description

State of Tennessee in Nashville is seeking a highly skilled Managed Care Specialist for TennCare. Under general supervision, you will perform highly technical TennCare program work, review applications, determine eligibility, and support enrollment.

You will mentor staff, use proprietary systems, handle inquiries, and coordinate with vendors and internal teams to ensure accurate benefits eligibility and timely service. A hybrid work arrangement is available.