Eligibility Specialist

Washington Health Benefit Exchange Eligibility Specialist

The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community. The 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. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.

The Washington Health Benefit Exchange (Exchange) receives thousands of applications for health insurance coverage each day via Washington Healthplanfinder. Using facts, discretion, and independent judgment, this position makes qualitative decisions regarding legal and regulatory compliance with the Affordable Care Act (ACA) by determining coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder. This includes reviewing documentation to verify citizenship, lawful presence, tribal enrollment, incarceration status, social security number, eligibility for other minimum essential coverage (MEC), and income attestations(s). 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. In addition, the incumbent will be expected to actively participate in quality assurance checks of eligibility rules, policies, guidance, and processes in our efforts to achieve continuous improvement.

Required: High School Diploma or equivalency. Two (2) years of experience explaining and applying complex regulations, laws and policies in a state, federal, health insurance or financial industry. One (1) year of demonstrated experience performing complex mathematical calculations, and strong attention to detail. Working knowledge of health care, health insurance, and Federal and State subsidy eligibility. Recognition and understanding of historical barriers to accessibility, and lasting impacts of inaccessibility. Ability to use Microsoft Office Software, including Teams, Outlook, SharePoint, Word, and PowerPoint, as well as complex spreadsheets, to include MS Excel, APTC Calculator and Income Averaging Calculator (or similar standard business tool). Demonstrated experience working independently, able to manage multiple projects efficiently, adapt to changing workload, and communicate effectively with stakeholders regarding deadlines. Demonstrated ability to use tools/information to solve problems. Systematic approach to researching, prior to making determinations, and/or asking for a second opinion if unsure. Effective communication oral/written while using appropriate language in routine situations, ability to adapt depending on the receiver and knowledge level. Mindful awareness of potential cultural, linguistic and or accessibility differences. Demonstrated experience protecting sensitive information (PII) and maintaining confidentiality. Demonstrated ability to communicate effectively with customers and co-workers, both orally and in writing, regarding complex or sensitive information or issues. Make accurate, independent assessments and calculations to ascertain validity of submitted documentation.

Full Salary Range: $56,907.00 to $85,361.00 annually, with midpoint at $71,134.00. Hiring Range: $65,443.00 and $71,134.00 annually. This is an estimate of where a qualified candidate can expect to receive an offer. The actual salary offer will consider candidate experience, skills, qualifications, internal equity, and the market. Our compensation policy reserves the salary range above the midpoint for employees who are meeting and exceeding expectations and for growth and development, up to the maximum.