Eligibility Specialist III

About the role

The Staff Development and Training Unit is seeking an experienced NC Medicaid Eligibility Specialist with a strong working knowledge of Family and Children's Medicaid (FCMA) or Adult Medicaid (AMED) policies. Candidates with strong knowledge of both programs are preferred.

Responsibilities

• Reviews FCMA and Adult Medicaid case records to confirm that the correct rules and Medicaid policy were followed.
• Identifies eligibility errors and internal control errors and documents findings in a clear, structured format.
• Produces written feedback reports for the Medicaid Services Division to support staff retention and ongoing improvement.
• Tracks error trends across staff and programs over time.
• Collaborates with staff across multiple teams and programs to align quality assurance findings with training needs.
• Aids in developing training content, including knowledge checks, interactive learning activities, and structured lesson plans.
• Navigates NC FAST and related systems to review case records and supporting documentation.
• Documents all quality assurance findings and actions in the appropriate case or tracking record.
• Participates in ongoing training and professional development as required.
• Participates in teams, committees, and unit initiatives as assigned.
• Performs related duties as required.

Requirements

Two years of NC Medicaid eligibility experience is required, with a strong working knowledge of either FCMA or Adult Medicaid policy; knowledge of both programs is a significant plus.

Qualifications

• A minimum of 2 years of NC Medicaid experience with a strong working knowledge of either FCMA or Adult Medicaid (AMED) policies and eligibility rules.
• Experience reviewing cases for eligibility errors and internal control errors.
• Ability to coordinate effectively with staff across multiple teams and programs within the division.
• Proficient working knowledge of NC FAST.
• Strong written and verbal communication skills.
• Experience training others or presenting policy in a clear and engaging way.
• Experience developing training content such as interactive learning games and activities, knowledge checks, or structured lesson plans.
• Strong working knowledge of both FCMA and Adult Medicaid (AMED) programs is a significant plus.
• Has worked in a Lead Worker, quality assurance, staff training, or mentoring role.
• Experience with data analytics, such as tracking error trends, summarizing audit findings, or analyzing case data to identify patterns.
• Strong organizational skills with the ability to manage competing priorities and meet deadlines.
• Ability to maintain regular and reliable attendance.
• Ability to establish and maintain effective working relationships with colleagues, community partners, and the general public.

Skills

• Interprets complex rules and regulations.
• Identifies eligibility and internal control errors.
• Produces clear written feedback.
• Interacts effectively with staff across multiple teams and programs.
• Coordinates with staff across multiple teams and programs to align quality assurance findings with training needs.
• Develops training content such as interactive learning games and activities, knowledge checks, or structured lesson plans.
• Trains others or presents policy in a clear and engaging way.
• Works with data analytics, such as tracking error trends and summarizing audit findings.
• Maintains regular and reliable attendance.
• Establishes and maintains effective working relationships with colleagues, community partners, and the general public.

Benefits

This position serves as a Staff Development Specialist (Senior Eligibility Specialist - Eligibility Specialist III) supporting the Staff Development and Training Unit within the Medicaid Services Division.

Pay

Details about pay will be provided upon hire.

Schedule

The role requires extensive daily use of a computer and associated systems to review Medicaid case records and produce quality assurance reports. This is an onsite position, Monday through Friday, 8:00 AM to 5:00 PM, in an office setting. An alternate schedule of 8:30 AM to 5:30 PM is available.