Become a part of our caring community and help us put health first
 

Join our amazing team at Inclusa/Humana in this exciting role as an Eligibility Specialist. The Eligibility Specialist role will provide expertise and support on the eligibility requirements and member financial obligations for Medicaid and Family Care. The Eligibility Specialist acts as a liaison between Inclusa, Income Maintenance (IM) agencies and Aging and Disability Resource Centers (ADRCs) to facilitate timely enrollment and disenrollment of Inclusa members.

Administering processes related to the enrollment and disenrollment of the organization’s membership.

• Analyze member enrollment information to determine if Medicaid and Family Care eligibility are active and accurately recorded in Forward Health.
• Validate newly enrolled member demographic information.
• Communicate with ADRC receipt of member enrollment.
• Accurately document member enrollment and disenrollment and provide timely notification to internal colleagues and external stakeholders.
• Analyze reports of changes in member situations to determine if the change may result in a member losing eligibility for services.

Providing necessary support to members to ensure ongoing financial eligibility and continued membership.

• Notify member and colleagues of renewals for financial eligibility.
• Provide education to members and legal decision makers on requirements for Medicaid and Family Care.
• Proactively partner with member and their supports to complete applications and obtain verifications required for Medicaid eligibility determination.
• Assists member and colleagues with their individual questions and/or concerns-via phone, secure email, letters etc.

Determining medical and health related expenses that allowed per contract to reduce member financial obligations to organization.

• Contact member, guardian of estate, financial power of attorney or representative payee to inform and educate on expenses that are allowed as deductions when determining the amount, if any, a member may need to pay towards his/her cost of care.
• Verify, document and report allowable member expenses to the appropriate internal and external parties.

Use your skills to make an impact
 

Required Qualifications

• Associates degree
• Microsoft technical experience in Word, Excel, Outlook
• 2 or more years of experience in eligibility requirements for Family Care and/or Medicaid.
• Must reside in the state of Wisconsin

Preferred Qualifications

• Bachelors degree

Additional Information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$44,200 - $60,900 per year

 

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Salary : $44,200 - $60,900