Benefits and Eligibility Specialist Advanced
Division of Member and Provider Services (DMPS)
Address: 801 E. Jefferson Street, Phoenix, AZ 85034
This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.
Salary: $46,000
Grade: 20
First Review of Resumes: March 25, 2025
Closing Date: Open until filled
This position provides technical consultation and support to a variety of program areas in DMPS. Researches, analyzes and interprets program rules to determine solutions to complex system problems and writes tickets for systematic fixes when necessary. Helps to prevent quality control errors by assisting in the correct determination of eligibility and enrollment.
The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.
Major duties and responsibilities include but are not limited to:
• Research and resolve daily, weekly and monthly reconciliation and operations reports. Possible resolutions include updating eligibility, Medicare enrollment, special programs and demographic information in HEAplus and/or directly in PMMIS. Reconcile discrepancies between eligibility and enrollment systems by performing root cause analysis, interpreting program rules, and elevating root-cause findings as appropriate.
• Provide technical consultation & support to a variety of customers, including DMPS & other AHCCCS staff as well as health plans & program contractors via phone calls or emails. Answer questions about system changes, review documents and resolve end user problems with systems used to determine eligibility. Ensure that when tickets are necessary, they are written accurately, with detail, and are descriptive to the root cause or issue.
• Participate in cross-functional and Arizona Management System (AMS) process improvement meetings and activities.
• Coordination of acquiring access to the many systems needed when employees are hired, are on extended leave, or are separated from DMPS. Conduct access audits when necessary.
Knowledge, Skills & Abilities (KSAs): |
Knowledge:
• AHCCCS policy and procedures regarding CHIP (KidsCare) and Medicaid including, but not limited to: ALTCS, MAGI, Non-MAGI, Medicare Savings Program, and SSI-MAO specialty categories
• Methodologies and standards for efficient and effective work procedures
• Troubleshooting techniques
• Arizona Management System (AMS)
• Customer service and support
Skills:
• Identifying and researching system vs. procedural errors and analyzing program logic
• Detail oriented
• Verbal and written communication
• Interpersonal interfacing with peers and other internal and external individuals of varying experience levels and backgrounds
• Google Suite and/or Microsoft Office products and proprietary healthcare computer systems such as HEAplus and PMMIS
• Coordination of and the follow through on complex research, problems and solutions.
• Collaboration and teamwork
• Customer service delivery
• Computer applications in word processing, spreadsheets, presentations, and email applications; Microsoft, Google. Proprietary state applications in Health-e-Arizona Plus, PMMIS, AZTECS, CATS, Electronic Member Change Reports (eMCR), DOCUWARE imaging application and the CISCO/Finesse telephone system
Abilities:
• Effectively communicate with internal/external customers
• Use numerous computer systems, databases and, programs to include but not limited to: HEAplus, PMMIS, DOCUWARE, AZTECS, CATS, eMCR and, Microsoft/Google email and word processing applications
• Identify and analyze procedural problems and execute or communicate effective solutions
• Express ideas and information clearly and concisely, both orally and in writing
• Establish and maintain effective, cooperative relationships as necessary to conduct work
Arizona Driver License
Minimum: Must have a high school diploma or General Equivalency Diploma (G.E.D) and 3 years of customer service experience.
Preferred: Two years of work experience equivalent to a Benefit & Eligibility Specialist or Program Services Evaluator (e.g., interviews and determines eligibility for public assistance benefits).
Pre-Employment Requirements: |
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
Learn more about the Paid Parental Leave pilot program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.