Medicaid Eligibility Specialist (Hybrid)

About the role

We’re hiring a Medicaid Eligibility Specialist who reports directly to the Outreach Supervisor. Conducts presentations throughout the community on the New Mexico Medicaid Program, meets with groups or individuals, and provides accurate information about the program. Assists beneficiaries in enrollment and eligibility assistance for potential and existing New Mexico Medicaid beneficiaries. Processes eligibility applications, determines eligibility, enters information into a web-based system, and follows up with beneficiaries via correspondence, file updates, and service assessments.

Responsibilities

• Support the research process unit for the SBE (state-based exchange).
• Determine eligibility for the NM Medicaid Program according to NM Medicaid Care regulations/guidelines by reviewing documentation, entering data into a web-based system, running automated eligibility rules, preparing correspondence for missing information, and making outbound calls to obtain, clarify, or validate information.
• Act as a seasoned processor with strong knowledge of all systems used for processing—serving as a subject matter expert.
• Process applications while maintaining an error rate of 5% or below.
• Assist in the call center when needed.
• Work independently on projects.
• Assist/train new staff when needed.
• Maintain good attendance and punctuality.
• Adhere to changes in policy and procedure.
• Provide clear, complete, accurate, and objective information based on a full understanding of program requirements.
• Build relationships with the community and advocacy groups.

Required Qualifications

• Must be 18 years of age or older.
• Have a High School Diploma or equivalent.
• Must be able to submit to pre-employment screening.
• Have legal authorization to work permanently in the United States without requiring a visa transfer or visa sponsorship.
• Have prior clerical/customer service work experience.
• Comfortable working within established processes and procedures.
• Strong communication and customer service skills.
• Reliable attendance and strong work ethic.

Preferred Qualifications

• Strong customer service, communication, and problem-solving skills.
• Experience handling escalated customer concerns and complex issues.
• Positive and energetic attitude.
• Ability to communicate clearly and confidently.
• Ability to multi-task and manage time effectively.
• Attention to detail, grammar, and spelling accuracy.
• Computer system experience with data entry and database documentation knowledge.

Benefits

• Medical, dental, and vision benefits from day one (for eligible roles).
• PerkSpot – Employee discount program.
• Paid time off and holidays.
• Paid training.
• Equipment provided.
• Career growth and advancement opportunities.
• Supportive and inclusive work environment.

Pay

$19.00 per hour (bi-weekly pay), which may be at or below the state’s minimum wage.

Schedule

• Full time: Monday–Friday, 8:00 AM–4:30 PM.
• Hybrid schedule: work from home 4 days per week and 1 day in the office (hybrid after training period).