WAIVER PROGRAMS ELIGIBILITY SPECIALIST - 08042026- 79579

Location: Nashville, TN (Davidson County) – hybrid work environment (combination of remote and in-office work based on position, department, and business need). This position requires a criminal background check.

Qualifications

Education and Experience:

• Bachelor’s degree from an accredited college or university, or
• Associate’s degree from an accredited college or university plus two years of qualifying professional experience in administrative, customer service, and/or data entry roles related to policy application, procedural execution, or eligibility within health/healthcare, casework, or insurance settings.

Substitution of Experience for Education:

• Qualifying professional experience (as described above) may substitute for education on a year-for-year basis, up to a maximum of four years.
• Two years of full-time work as a Managed Care Specialist with the State of Tennessee may substitute for the required education.

Necessary Special Qualifications:

• A valid motor vehicle operator’s license may be required.

About the Role

Under general supervision, this position involves highly technical professional work or supervisory responsibilities within the TennCare program. Responsibilities include performing complex TennCare program tasks or supervising a small to moderate unit of Managed Care Specialists and/or sub-professional staff. This role is distinguished from lower-level positions by its focus on highly technical or supervisory duties.

Responsibilities

Eligibility Determination

• Review individual applicant applications and enrollee income, resources, and other technical elements to determine eligibility.
• Register applications as needed and make changes to member eligibility.
• Establish and maintain accurate member caseloads through report processing.
• Troubleshoot and respond to inquiries regarding member eligibility.
• Demonstrate strong customer service skills, including interpretation of public policy and problem-solving.
• Use proprietary computer-based systems to perform work duties.
• Respond to emails, telephone calls, and other correspondence in a timely manner.

Customer Service and Time Management

• Work systematically in partnership with vendor staff, internal customers, and external stakeholders to support a shared client base.
• Communicate verbally and electronically with vendors, internal customers, and outside organizations to obtain or share eligibility-related information and resolve issues.
• Manage ambiguity, prioritize tasks, and request guidance or training in areas of uncertainty.
• Participate in required training and strive for continuous professional development to better support peers and customers.
• Exercise professional judgment to escalate concerns or issues as needed.

Communication

• Stay updated on new policies and procedures to ensure accurate eligibility determinations.
• Explain eligibility for benefits and services clearly and accurately.
• Interpret policy and procedure in relation to enrollee circumstances to ensure understanding.
• Communicate enrollee/applicant responsibilities in an easily understandable manner.

Training and Mentorship

• Mentor new and less experienced employees to ensure understanding of processes and information.
• Conduct or lead training to promote continual learning and current knowledge in the managed care field.

Skills and Competencies

Competencies

• Manages Complexity
• Organizational Savvy
• Directs Work
• Communicates Effectively
• Instills Trust

Knowledge Areas

• Communication and Media
• Administration and Management
• Customer and Personal Service
• Law and Government
• Education and Training

Skills

• Active Learning and Listening
• Complex Problem Solving
• Judgment and Decision Making
• Monitoring
• Time Management

Abilities

• Written Comprehension
• Inductive Reasoning
• Speech Clarity
• Oral Expression
• Problem Sensitivity

Tools & Equipment

• Personal Computer
• Telephone
• Fax Machine
• Printer

Pay

Annual Salary: $43,572.00 (Monthly Salary: $3,631.00)

Schedule

Full-Time