Medicaid Eligibility Specialist

About FEDlogic

FEDlogic is a people-first company specializing in benefits navigation aimed at assisting individuals and families in understanding and accessing federal and state benefits. It is the sole provider nationwide offering impartial education and advocacy across all federal and state programs. Collaborating with employers, FEDlogic supports employees and their families by providing confidential, unbiased guidance, easing healthcare expenses, relieving financial burdens, and enhancing overall well-being. The company's role bridges government programs with employer benefits, positively impacting employee welfare while aiding employers in risk management, cost reduction, and benefits enhancement.

Role Overview

The Medicaid Eligibility Specialist will work remotely with some travel (up to 10% annually) and report to the Director of Expert Services. This full-time role requires a seasoned expert with a minimum of 10 years' experience in Medicaid eligibility across diverse populations and programs. The specialist will offer comprehensive expertise, assist clients in navigating complex Medicaid policies, resolve eligibility challenges, and ensure adherence to federal and state regulations.

Key Responsibilities

• Provide expert knowledge on Medicaid eligibility criteria, including MAGI, ABD, Medically Needy, and waiver programs.
• Evaluate complex eligibility situations and supply technical support to both internal teams and external stakeholders.
• Interpret and apply relevant regulations from state and federal authorities, including CMS directives and waiver provisions, to practical eligibility cases.
• Participate in system design, testing, and policy execution related to Medicaid eligibility workflows.
• Create and deliver educational materials and training sessions for eligibility staff, supervisors, and partners.
• Assist quality assurance efforts by reviewing cases, identifying policy gaps, and recommending training improvements.
• Communicate regularly with customers and government agencies to clarify and update eligibility policies.
• Perform additional duties as designated by leadership.

Required Qualifications

• At least 10 years of direct involvement in Medicaid eligibility determination, policy analysis, or training.
• Minimum 3 years of experience in customer service, healthcare navigation, benefits administration, or case management.
• Comprehensive understanding of Medicaid eligibility rules governed by SSA, CMS, and state-specific implementations.
• Experience with 1634 and 209(b) state models, spend-down programs, and eligibility system operations.
• Strong analytical capabilities, meticulous attention to detail, and excellent documentation skills.
• Excellent written and verbal communication along with effective stakeholder engagement abilities.
• Ability to thrive in a dynamic, service-driven workplace.
• Capability to manage sensitive and confidential medical information with discretion.
• Proficiency in Customer Relationship Management tools such as Salesforce and Tableau, workforce management platforms, Google Workplace, Slack, and minimal familiarity with Microsoft Office.

Preferred Qualifications

• Bachelor's degree in Public Policy, Health Administration, Social Work, or related fields; Master's degree preferred.
• Knowledge of how Medicaid intersects with SNAP, SSI, Medicare, and CHIP programs.
• Previous involvement in system integration or modernization initiatives targeting eligibility processes.
• Spanish language skills considered an asset.
• Strong customer service orientation and ability to provide exceptional service experiences.

Compensation and Benefits

• This position offers an annual salary ranging from $52,000 to $65,000 USD.
• Flexible remote working arrangements.
• Paid Time Off inclusive of all federal holidays.
• Comprehensive insurance benefits covering health, dental, vision, group term life, short-term and long-term disability, plus various voluntary plans.
• Paid family leave including maternity, paternity, and adoption benefits.
• Supplemental plan for cancer expert services.
• 401(k) retirement plan with employer matching contributions.
• Collaborative and supportive workplace environment with growth opportunities.

Additional Information

Travel requirements include up to 10% annual travel for client meetings and company events, both locally and occasionally out-of-town.

FEDlogic is an equal opportunity employer committed to diversity and inclusion without regard to legally protected characteristics.

Employment screening may include consumer or investigative reports as part of the hiring process.