Become a part of our caring community

Join us at Humana as an Eligibility Specialist, where your passion for supporting members will shine. Reporting to the Supervisor of Care Management Support, you will guide members and their care teams through Medicaid and Family Care eligibility processes, provide direct support with applications and verifications, educate members on program requirements, and assess health-related expenses to help reduce financial obligations. Your strong communication and organizational skills, and your understanding of Medicaid policies, will help you ensure compliance and continuity of care.

Main Responsibilities:

• Notify members and colleagues of financial eligibility renewal requirements.
• Educate members and legal decision-makers on Medicaid and Family Care requirements.
• Assist members and their support networks with completing applications and obtaining necessary verifications for Medicaid eligibility determination.
• Address member and colleague questions by phone, secure email, and written correspondence.
• Assess allowable medical and health-related expenses that can reduce member financial obligations.
• Communicate with members, guardians, financial power of attorneys, or representative payees to inform and educate them on deductible expenses.
• Verify, document, and report allowable member expenses to appropriate internal and external parties.
• Follow professional standards, regulations, and organizational procedures while making informed decisions regarding work priorities and approach.

Use your skills to make an impact Required Qualifications

• 5 or more years of Microsoft Office Suite, Word, Excel, Outlook.
• 1 or more years of experience in eligibility Medicaid, Family Care, or other public assistance programs
• Must reside within the State of WI
• Demonstrated ability to review financial and medical documentation with a high degree of accuracy and attention to detail

Preferred Qualifications

• Associate or bachelor's degree in a related field
• 1 year of familiarity with CARES, Forward Health, and Electronic Case Filing (ECF) system.
• Experience collaborating with Aging and Disability Resource Centers (ADRCs), Income Maintenance (IM) Consortia, and Social Security Administration (SSA)
• Experience working with vulnerable populations, including individuals with disabilities and elderly adults.

Additional Information

• Workstyle:

Home

• Typical Work Days/Hours:

Monday through Friday, 8:00 am – 4:30 pm CST.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Hire View

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule

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Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$45,400 - $61,300 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 a leading U.S. healthcare company. Through our Humana insurance services and our Center Well 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at Center Well.com.

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.