Specialty Health Customer Support Specialist

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Functional Title: Specialty Health Customer Support Specialist
Job Title: Eligibility Advisor IV
Agency: Health & Human Services Comm
Department: KHC Admin
Posting Number: 13969
Closing Date: 03/16/2026
Posting Audience: Internal and External
Occupational Category: Community and Social Services
Salary Range: $3,409.83 - $4,252.00
Pay Frequency: Monthly
Salary Group: TEXAS-B-16
Shift: Day
Additional Shift:
Telework:
Travel:
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Nonexempt
Facility Location:
Job Location City: AUSTIN
Job Location Address: 701 W 51ST ST
Other Locations:
MOS Codes: No military equivalent

Brief Job Description:

Under the general direction of the Specialty Health Customer Support Supervisor, performs highly complex (senior-level) eligibility activities for the Kidney Health Care (KHC), Children with Special Health Care Needs (CSHCN) Services Program, and the Hemophilia Assistance Program (HAP). This position performs client record updates that may or may not impact eligibility for the programs, and responds to inquiries received on the customer service toll free and local area phone lines as well as by mail, email, and fax. This position resolves complaints and escalates issues as necessary; consults with program staff on policies, practices, records and community resources. Responds to inquiries regarding eligibility determination of benefits. Documents case records to maintain accurate and confidential client records. Works under minimal supervision, with considerable latitude for the use of initiative and independent judgment.

Essential Job Functions (EJFs):

SH Program Guidance and Information Updates
Provides accurate program specific information and performs client record update activities for eligibility determination for Specialty Health programs including KHC, CSHCN and HAP. Responds to requests for program information and updates received primarily through the customer service phone lines, and those received by fax, mail and/or email for all programs within office. Responds to high call volumes. Responds to information requests, inquiries and updates received from the recipients, providers, other agencies, and the public. Types of inquiries and requests are for eligibility and claims status, explanation of benefits, program limitations, rules, policies, and procedures and for request to change and update recipient records. Maintains quality expectations set out by quality improvement metrics and management. Uses Specialty Health’s system of record (both manual and automated) to research information to respond to inquiries and service requests. May refer callers to available providers in their area and to other Health and Human Services programs. Routes calls to appropriate program staff as needed. Prepares special reports or summaries of findings regarding travel reimbursements (25%).

Customer Support and Issue Resolution
Handles difficult, sensitive or escalated customer cases requiring advanced judgment and problem-solving.
Communicates application status or travel reimbursement status clearly, while ensuring customers understand next steps, rights and responsibilities. Provides referrals for additional services when customer needs extend beyond SH. Assists with mailing customer services documents to ensure prompt, accurate and efficient customer service delivery (25%).

Collaboration and Team Support
Works with supervisors, other team members and SH Eligibility team to coordinate services and ensure client, social worker and case manager communication and guidance is current, accurate, professional and helpful. Participate in team meetings, trainings and continuous improvement initiatives. Shares best practices and assists with onboarding or training new staff when needed (15%).

Compliance and Quality Assurance
Maintain precise documentation of actions for KHC, CSHCN and HAP clients in agency systems, ensuring all data is complete and compliant for eligibility determinations, verifications and payment processing. Ensure meeting standards for timeliness and accuracy in all client record updates and entries. Manage assigned caseload efficiently while meeting productivity and quality standards. Maintain confidentiality and follow all HIPAA and privacy standards. Participate in audits, quality reviews and error-correction processes. Keeps up-to-date with policy changes and updates procedures accordingly (15%).

Communication, Outreach and Program Education
Serve as a primary subject matter expert to internal and external customers and other stakeholders on program eligibility guidance and program processes. Assist all stakeholders in understanding SH eligibility rules and requirements, travel reimbursement processes, and client record update processes. Offer concise answers and provides easily understandable examples of system processes. Attend meetings and conference calls as assigned to provide expertise and stay knowledgeable of current changes to the program by attending trainings and staying knowledgeable with updates to policy and procedure manuals (15%).

Other duties as assigned
Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location (5%).

Knowledge, Skills and Abilities (KSAs):

Knowledge of state and federal program eligibility guidelines, regulations, and policies; social services eligibility requirements; and community welfare resources.
Knowledge of programs which support client populations served by Specialty Health.
Knowledge of benefits and eligibility determination processes.
Knowledge of individual healthcare needs associated with special health care needs/disabilities and related community-based resources.

Skill in interviewing, in conducting individual needs assessments, and in the use of a computer and applicable software.
Skills in providing customer service to a wide range of customers, including patients, providers, and the public.
Skill in providing technical assistance to providers, clients, and professional staff.
Skills in using multiple manual and automated systems to support business processes.
Skill in navigating and interpreting interagency policies and procedures.
Skill in the use of Microsoft Office products.
Skill in customer service support via phone and email correspondence.

Ability to work and communicate effectively as a team member and in work groups.
Ability to communicate verbally and in writing in an effective, tactful, and diplomatic manner.
Ability to work under pressure and manage multiple assignments with minimal supervision.
Ability to develop and interpret policies and procedures specific to customer service delivery
Ability to respond to customer complaints in a professional and courteous manner.
Ability to appropriately convey instructions and provide supportive feedback to clients and interested parties.
Ability to maintain effective working relationships, to elicit and evaluate information, to research and investigate, to perform basic arithmetic and data analysis, and to communicate effectively.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

At least three years’ experience in customer service or administrative support work within a health and human services field.

Experience providing customer support in a call-center environment.

Experience in social services, financial eligibility determination, or investigative work.

Preferred:

Fluent in both English and Spanish.

Experience with Medicare, Medicaid, and CHIP regulations relating to eligibility, coordination of benefits, insurance, and third party coverage.

Skills in providing quality customer service to clients and providers regarding complex eligibility requirements and benefits.

Additional Information:

N/A

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.