Eligibility Specialist Resume Samples

An Eligibility Specialist will determine if the applicant meets the necessary criteria for getting qualified for various programs. A well-drafted Eligibility Specialist Resume mentions the following duties and tasks – gathering information pertaining to public assistance program applications, identifying the required client data, verifying reviewing submitted applications, gathering admission forms, judging the competence of the candidates, sending letter of acceptance to selected candidates, reviewing application and checking if the application is worthy of scholarship, and rejecting applications that don’t fulfil the admission criteria.

While the job description may vary based on the industry, the required skills are common and include these – a thorough knowledge of the rules protocols pertaining to the industry, analytical skills, proficiency in the documentation, and sound researching skills. Education requirements vary for this position, but successful resumes depict a degree in relevant fields.

 

Eligibility Specialist Resume example

Eligibility Specialist Resume

Objective : Motivated, personable business professional with a talent for quickly mastering technology, rules, and regulations. Diplomatic and tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Demonstrated history of producing accurate, timely reports meeting stringent guidelines. Flexible and versatile - able to maintain a sense of humor under pressure.

Skills : Proficient in English & Spanish - verbal and written.

Description :

    1. Performed intermediate administrative work evaluating and explaining program benefits and eligibility requirements to applicants and clients, processing applications and recertification, according to county, state and federal policies, statutes and guidelines, and related work as apparent or assigned.
    2. Processed case specific information for applications, recertification and unscheduled reported changes into state and county databases.
    3. Determined eligibility for a variety of county, state and federal public assistance programs.
    4. Advised clients on viable life options; provides referrals for other resources; promotes self-sufficiency.
    5. Worked in cooperation and coordination with other county staff, local, state and federal agencies, service providers or vendors to provide client services.
    6. Responsible for up to 800 foster care cases.
    7. Responded to client concerns and complaints; informs clients of their appeal rights and the appeals process.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Biology


Eligibility Specialist Resume

Summary : Eligibility Specialist with 3 years of experience in communicating with clients and other internal departments, Responsible for accuracy, consistency, and meeting quota expectations.

Skills : Management Skills, Inventory.

Description :

    1. Eligibility Determiner Administered the intake, assessment, and eligibility process for JTPA, Veterans Program, Three Rivers Youth, and Older Adult Employment Program, SPOC, Female Offenders Program, and Renewal Inc.
    2. Reviewed applications in detail to determine eligibility status of clients and explained available services.
    3. Trained as an Administrative Assistant to the Helpline/United Way agency representative on site.
    4. Identified client's supportive service needs and made appropriate referrals.
    5. Administered and scored employment and training evaluation tests.
    6. Accurately completed agency forms and input data into computer.
    7. Organized and maintained efficient records and effectively communicated with clients.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Certificate Of Completion


Healthcare Eligibility Specialist Resume

Objective : A professional receptionist/ front office assistant with solid track-record of consistently meeting assigned goals and objectives through self-discipline, perseverance and motivation. Confident and poised in interactions with individuals at all levels. Detail-oriented and resourceful in completing projects with the ability to multitask effectively in a timely manner. Versatile professional with hands-on experience in diverse industries operating multiple functions nationally.

Skills : Microsoft Office, ICES, FACTS, SMART, Excel,Word, multiple systems in unison.

Description :

    1. Determined client eligibility for the program by using HUD Income Limits.
    2. Processed Lease Renewals, Lease Adjustments, Unit Transfers, and New Lease Contracts for tenants via Lindsey Software.
    3. Initiated and investigated tenant fraud cases, monitor repayment agreements to the agency, monitor Debts Owed.
    4. Issued vouchers during Voucher sessions, assist tenants/landlords with Agency and HUD guidelines.
    5. Performed intake when agency is taking applications for assistance and place eligible clients on the waiting list.
    6. Performed background checks for potential tenants.
    7. Represented agency during tenant requested hearings.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Social Work

Medicaid Eligibility Specialist Resume

Objective : Hard working and fully certified Medical Coding Specialist seeking an opportunity in a medical administrative environment. Solid continuous work history showing a track record efficiency and accuracy. Proven ability to meet deadlines in high pressure environments with keen attention to detail. Extensive work in medical billing makes me an important key asset to any organization.

Skills : Word, Managing Skills.

Description :

    1. Ensured compliance with all processes and procedures, and directives pertaining to paratransit and fixed-route systems that affect paratransit customers Ensures that all eligibility determinations for MetroAccess are processed accurately and within 21 days or less from receipt of a completed application.
    2. Ensured applicants who meet the guidelines of the ADA are determined eligible for the appropriate level of paratransit service.
    3. Worked with leadership and colleagues to refine processes and procedures to achieve greater efficiency and cost-effectiveness.
    4. Conducted an assessment of the travel skills and goals of people with disabilities and senior citizens through interviews and observations.
    5. Printed MetroAccess ID cards and mail them to customers when they are eligible for the service.
    6. Ensured that all customer data is correct before printing and mailing the MetroAccess ID cards.
    7. Provided quality customer service to internal and external customers.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's Of Science In Nursing

Bilingual Eligibility Specialist Resume

Objective : Motivated customer service specialist with 3 years of experience in telephone customer service, including sales, tech support, and customer care. Familiar with major customer service software, conflict resolution, and posses a positive attitude. Utilizing my proven skills, I believe I am able to effectively fill any office position.

Skills : Answering Phones, Schedule Appointments, Insurance Verification, Medical Records, Medical Billing, Collections, Cash Handling, Interpreting, Training, Case Processing.

Description :

    1. Analyzed process and determined electronic applications for FAMIS and FAMIS Plus state health insurance for pregnant women and children using CHAMPS and MMIS.
    2. Contacted clients when the application is deficient for needed information Send letters to clients when the application is deficient using CHAMPS.
    3. Analyzed, verified, and calculated earned and unearned income, including pay stubs, unemployment, SSA, etc.
    4. Routed applications and verifications to appropriate queue using office computer software ODM.
    5. Understood and followed regulations for state eligibility.
    6. Completed correction, cancellation, address and transfer reports as needed.
    7. Communicated with local Department of Social Services via appropriate office forms when necessary.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Creative Advertising

Benefits Eligibility Specialist Resume

Headline : An experienced and goal-oriented professional with a track record of consistently achieving and exceeding established goals and objectives related to management, training, education, and client relations. 

Skills : Type 75 WPM, Fluent in American Sign Language, Dental and Medical Front and Back Office.

Description :

    1. Answered telephone calls to troubleshoot problems, and schedule assessment appointments.
    2. Assisted Director with processing monthly rent checks to landlords.
    3. Completed various clerical tasks associated with customer service.
    4. Performed intake and assessment for new applicants for financial and health care programs to determine eligibility for services, issues program benefits for eligible clients, and monitors continued compliance and eligibility.
    5. Interviewed and/or screened clients in person and by phone to explain program eligibility and requirements.
    6. Assisted clients with the application process.
    7. verified income, financial resources, work history, assess client needs and makes referrals to other agencies, programs, and community resources; processes applications to determine appropriate program benefits.
                      Years of Experience
                      Experience
                      5-7 Years
                      Experience Level
                      Level
                      Consultant
                      Education
                      Education
                      Creative Advertising

                      Employment And Eligibility Specialist Resume

                      Summary : Eligibility Specialist with a background in customer service, casino work, and call centers. Warm, outgoing personality with the ability to interact successfully with persons of all ages and backgrounds.

                      Skills : Microsoft Office, Apple iWorks.

                      Description :

                        1. Greeted participants entering the help center in a positive, professional and friendly manner.
                        2. Gathered information from the participant to best direct them to services.
                        3. Received, routed and responded to phone calls.
                        4. Scheduled/Rescheduled appointments and follow up on no shows.
                        5. Tracked Medicaid disability claims and medical records.
                        6. Met with participants to determine eligibility for federal or state funded programs.
                        7. Maintained confidentiality of patient health information in compliance with HIPAA regulations.
                      Years of Experience
                      Experience
                      7-10 Years
                      Experience Level
                      Level
                      Management
                      Education
                      Education
                      High School Diploma

                      Eligibility Specialist Case Manager Resume

                      Objective : Dynamic team leader with more than ten years of exceptional customer service experience with a demonstrated record of success working in the customer service industry. Excellent communication and interpersonal skills with a keen ability to, articulate requirements and provide solutions. Motivated professional with a strong passion for human flourishing and public M service.

                      Skills : Management Skills, Communication Skills.

                      Description :

                        1. Reviewed applications ensuring that applications are filled out correctly and fully and contacting applicants and or others to verify the information supplied on applications.
                        2. Processed applications which includes performing social summaries, obtaining releases, collecting medical records.
                        3. Assisted applicants in determining verification of income, assets, and other legal and financial documents.
                        4. Explained various programs provided, verify documents as necessary and explain the regulations to meet the program requirements.
                        5. Entered information into the automated system to determine eligibility for Medicaid and other state programs.
                        6. Processed, read, and interpreted data elements on all applicable systems to provide support, resolve inquires, and educate callers.
                        7. Processed enrollments Fees, plan changes, and disenrollments.
                      Years of Experience
                      Experience
                      0-2 Years
                      Experience Level
                      Level
                      Entry Level
                      Education
                      Education
                      Bachelor Of Science

                      Eligibility Specialist Resume

                      Summary : Serving as a resource and provides training to other staff members, communicating information with internal and external partners on County, State, and Federal guidelines.

                      Skills : Microsoft Office, Communication Skills.

                      Description :

                        1. Screened and Interviewed Applicants to determine initial and on-going eligibility services.
                        2. Developed detailed, Individualized case management plans for clients.
                        3. Conducted home visits field reviews using OR access, CAPS assessment tool, and laptop.
                        4. Interviewed clients, and updated OR ACCESS computer system to input information.
                        5. Used MMIS to verify, collect and enter accurate data for benefit Issuance.
                        6. Worked in cooperation with other DHS agencies and community partners to develop integrated service plans.
                        7. Assisted clients by problem-solving, providing tools such as administrative hearings requests, consumer comment forms, alternate formats, and civil rights forms.
                      Years of Experience
                      Experience
                      7-10 Years
                      Experience Level
                      Level
                      Consultant
                      Education
                      Education
                      Associates In Social Work

                      Eligibility Specialist Resume

                      Headline : To obtain a challenging Eligibility Specialist position in the insurance field where my skills and knowledge will develop to help my growth within a fortune five hundred company.

                      Skills : Microsoft Office, Multitasking.

                      Description :

                        1. Provided the highest quality of customer service to patients and client representatives, which entail acquiring in-depth knowledge of client and marketing requirements.
                        2. Completed Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has when starting therapy.
                        3. Reviewed incoming referrals for completeness and confirm all requirements are met.
                        4. Typically received via facsimile, Web portal, or client partner download.
                        5. Completed verification of Benefits and Eligibility for all referrals from patients, MDOs, health plans, and pharmaceutical manufacturers.
                        6. Investigated benefits and eligibility by phone and/or internet to determine coverage choices patient has when starting therapy.
                        7. Assisted clients in finding either In-home care or Residential care facility, based upon care needs.
                      Years of Experience
                      Experience
                      5-7 Years
                      Experience Level
                      Level
                      Management
                      Education
                      Education
                      High School Diploma

                      Eligibility Specialist/Patient Advocate Resume

                      Summary : Responding to questions from clients, outside facilities, agencies, and vendors regarding client benefits and eligibility, Performing case management activities, and also Developing and maintaining knowledge of public assistance programs.

                      Skills : Microsoft Office Programs, Office Applications, Office Administration, Networking, Receptionist, Switchboard, Government Relations, Medical Terminology, Public Relations.

                      Description :

                        1. Provided administrative support to department supervisors and staff.
                        2. Processed initial review of health care insurance applications and required documentation.
                        3. Maintained a well-organized filing system that allowed for easy tracking of information.
                        4. Opened, sorted, organized, distributed, and responded to mail and email.
                        5. Filtered through high volume of telephone calls with responsibility for timely follow up.
                        6. Learned to work efficiently under pressure.
                        7. Reviewed data records, charts, and reports for data entry.
                      Years of Experience
                      Experience
                      7-10 Years
                      Experience Level
                      Level
                      Management
                      Education
                      Education
                      High School Diploma

                      Eligibility Specialist Resume

                      Summary : Entering information into and reviews State database(s) regarding client eligibility and benefit programs, Checking interfaces with other County, State, and Federal agencies and departments, and also Verifying the accuracy of benefit determination.Notified clients of determination.

                      Skills : Customer Services, Medical Terminology, Computer Skills.

                      Description :

                        1. Processed applications, re-determinations and other supporting documents relevant to cases.
                        2. Reviewed applications for eligibility requirements and completeness.
                        3. Entered enrollment data into computer system.
                        4. Followed up with consumer contacts with correspondence to clarify information or update files.
                        5. Finalized eligibility once all pertinent information added into the system.
                        6. Reported any technical problems with equipment, systems, or facilities to the Manager.
                        7. Determined if consumer meets eligibility requirements.
                      Years of Experience
                      Experience
                      7-10 Years
                      Experience Level
                      Level
                      Consultant
                      Education
                      Education
                      BS