Eligibility Specialist II Team Lead (LTC) / 61061878

Job Responsibilities

• Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists
  • In addition to meeting minimum standards for timely determinations in accordance with the Department’s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team. Provides weekly individualized guidance for up to 4 team members and provides recommendations for the relevant team supervisor for performance evaluations and periodic counseling. Assists new and underperforming team members with developing work improvement strategies.
• Proficient with all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations as to individual eligibility based on the rules and standards detailed by the department as defined in written performance standards for the relevant type of determination needed. Resolves discrepancies in a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately, and in the appropriate systems of record.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.
• Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Minimum and Additional Requirements

A high school diploma and experience in customer services, social services, human services, and/or Medicaid processing.

A bachelor's degree may be substituted for the required program experience.

• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.

Preferred Qualifications

• Extensive knowledge of the Medicaid program.
• Ability to analyze and interpret broad health and human services issues and their impact on the Department programs.
• Knowledge of laws, regulations, policies, and procedures relevant to the area of employment.
• Ability to exercise judgement and discretion.
• Ability to establish and maintain effective working relationships.
• Ability to communicate effectively both orally and in writing.
• Ability to effectively manage time and prioritize tasks and projects with competing and/or shifting deadlines.
• Must be able to lead and manage a diverse staff.
• Ability to communication and collaborate with staff from different levels of the workforce.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.