Eligibility Specialist

The Eligibility Specialist will determine coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder. The incumbent must determine the customer’s eligibility for tax credits and/or enrollment in a qualified health or dental plan in accordance with the ACA, regulations, laws, policies, and established business processes.

• Determine coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder
• Review documentation to verify citizenship, lawful presence, tribal enrollment, incarceration status, social security number, eligibility for other minimum essential coverage, and income attestations
• Explain complex requirements and federally mandated timelines to customers
• Validate and reconcile customer-supplied documents against customer attestation
• Adhere to changes in Federal regulations, state law, and WAHBE policies that dictate eligibility for job functions and duties

• Working knowledge of the Affordable Care Act, Medicaid, the commercial health insurance market, and Federal and State subsidy programs
• Maintain a working knowledge and understanding of conditional eligibility verification regulations, laws, policies and guidance, and operation of the prescribed computer programs
• Use and manage multiple complex computer systems and databases simultaneously to make accurate determinations regarding the customer’s lawful presence or citizenship status, income, social security number, incarceration status, tribal enrollment, and access to other, minimum essential coverage

• Health insurance
• 401k matching
• Paid leave
• Staff training and other compensation benefits

The Washington Health Benefit Exchange (Exchange) is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage.