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Overview

The Eligibility Specialist classifications determine the eligibility of applicants and recipients for public assistance programs through interactive interviewing and fact gathering; maintain current knowledge of program regulations and procedures necessary for multi-program caseload administration; initiate and process casework through automated systems; identify needs and make appropriate referrals for health, social, and/or employment services; and perform related work as required.

EXAMPLES OF DUTIES: Duties may include, but are not limited to, the following:
(For Eligibility Specialist I, duties are performed at the entry level.)

  • Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and determine eligibility for public assistance programs and services
  • Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
  • Explains regulations, rules and policies to clients and apprises them of their rights,
    responsibilities and eligibility for participation in various public assistance programs and services
  • Ensures accuracy and completion of application and declaration forms
  • Resolves discrepancies by securing documentation, medical records and confirmation from other agencies
  • Enters and retrieves numerical and narrative data and issues benefits from an automated computer system
  • Determines the level of benefits to which the client is entitled by making complex computations and/or computer entries and then analyzing the results
  • Reviews and interprets information provided on a variety of forms both by the client and third parties to assist with eligibility determination
  • Evaluates clients for and answers questions on Advanced Payment Tax Credits (APTC) related to health care reform
  • Explains a variety of plan options, costs and individual plan features through Covered California
  • Monitors on-going eligibility by obtaining periodic updated information of eligibility factors
    and takes appropriate actions on changes
  • Determines need for additional services and makes referrals as needed for employment and other services to outside agencies to assist clients toward self-sufficiency and directs clients accordingly
  • Organizes and prioritizes caseload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
  • Enters and maintains case records, including written narratives, forms and computer documents in a clear and readable format
  • Troubleshoots task and/or case issues to determine appropriate resolution of problems, involving Help Desk as needed
  • Communicates both orally and in writing with clients and others related to the initial and ongoing eligibility determination while maintaining confidentiality
  • Responds to questions and complaints of clients in person, by telephone, mail and/or email communication
  • Provides pertinent forms and pamphlets to clients as required
  • Identifies suspected fraud and makes referrals for investigation
  • Makes referrals to social service workers as needed
  • Participates in special projects, studies, work assignments and committees
  • Prepares correspondence and reports
  • Performs related duties as assigned

EMPLOYMENT STANDARDS

Note: The level and scope of the knowledge and skills listed below are related to job duties as
distinguished between the two levels in the Definition section.

Knowledge of:

  • General goals and purpose of public social services programs
  • Laws, rules, regulations, policies and procedures governing eligibility for diverse public assistance programs and related case administrative techniques
  • Methods and techniques of conducting an investigative interview and information gathering
  • Computer terminology and computer keyboard arrangement
  • Modern office practices, methods and procedures
  • Record keeping practices and procedures
  • Principles of mathematical calculations
  • Intricacies of health insurance plans, medical health plan options and associated terminology
  • Regulations and rules regarding household filing status related to the Affordable Care Act
  • Cultural and human behavior, including knowledge of self, to interact effectively with clients and staff
  • Principles and practices of effective customer service
  • Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
  • Modern equipment and communication tools used for business functions and program,
    project and task coordination
  • Computers and software programs (e.g., Microsoft software applications) to conduct
    research, assess information and/or prepare documentation

Ability to:

  • Apply the policies, procedures and programs of the County Social Services Department
  • Apply the laws, rules and regulations governing eligibility and grant determination for
    multiple public assistance programs and the case administration of these programs
  • Identify available resources and communicate with others to obtain and verify information
    concerning eligibility
  • Use fact finding techniques and perform in-depth and interactive interviewing
  • Determine appropriate course of action in emergency situations
  • Make referrals to appropriate agencies and social service programs
  • Detect and evaluate potential fraudulent situations
  • Analyze and interpret written, numerical and verbal data from various sources
  • Utilize multiple electronic information, social services systems and analyze and interpret
    such information
  • Enter and maintain data accurately and timely into a computerized system
  • Navigate through computer screens and effectively use computer systems, software
    applications and modern business equipment to perform a variety of work tasks
  • Identify when computer output is incorrect and make corrections
  • Process cases manually as required
  • Plan and organize caseload to ensure work is completed in accordance with regulations
    relating to eligibility and timeliness
  • Function effectively in a system with strict deadlines and constant changes
  • Read, understand, apply and explain complicated and detailed correspondence, reports,
    regulations and policy directives
  • Perform a variety of mathematical computations accurately and rapidly
  • Prepare clear, concise and accurate records and reports
  • Explain complex rules and programs so they can be understood by people of diverse
    socio-economic, cultural and educational backgrounds
  • Gather, record and correctly evaluate tax filing data, income and additional necessary
    information required for the determination of eligibility for one or more programs
  • Explain health insurance plan options and plan details available to clients through
    theAffordable Care Act
  • Review a variety of tax documents to obtain needed household filing information
  • Explain health care reform tax credit implications to clients
  • Refer clients to other community services as needed
  • Assess and manage difficult and hostile persons or situations; or call for intervention when
    appropriate
  • Interact with people in a courteous manner in person, on the telephone, by mail or email
  • Work in a fast-paced, professional office environment and prioritize a wide range of duties
    with varying time requirements to ensure timely completion
  • Communicate clearly and concisely, both orally and in writing, using appropriate English
    grammar and syntax
  • Establish and maintain cooperative working relationships with the public and staff
  • Follow written and oral directions and instructions

MINIMUM QUALIFICATIONS:

  • Eligibility Specialist I:
  • Pattern 1: One year full-time experience in an Eligibility Specialist Trainee classification in an Interagency Merit System (IMS) county;
    OR
  • Pattern 2: One (1) year of full-time experience determining eligibility for health programs, loans,
    financial assistance, unemployment, or other benefits and two (2) years of clerical work involving
    public contact;
    OR
  • Pattern 3: Two (2) years of full-time experience determining eligibility for health programs, loans,
    financial assistance, unemployment, or other benefits;
    OR
  • Pattern 4: Four (4) years of full-time clerical work involving public contact, interviewing, math
    computations, completion of forms or eliciting information from the public;
    OR
  • Pattern 5:Graduation from an accredited four-year college or university.
  • Qualifying experience or education may be combined in order to meet the above requirements.
  • When combining education and experience; fifteen (15) semester units or twenty-two and a half
    (22.5) quarter units equals six months of experience.
  • Eligibility Specialist II:
  • One (1) year full time experience in an Eligibility Specialist I classification in an Interagency Merit
    System (IMS) County;
    OR
  • Two (2) years of full time experience determining eligibility for public assistance programs in a
    public human services agency.

SUPPLEMENTAL INFORMATION:
ADDITIONAL INFORMATION

  • The ability to speak, read, and write Spanish in addition to English would be an asset in
    this position, but is not required. Applicants for English/Spanish bilingual designated
    positions must take and pass the bilingual proficiency examination administered by
    CalHR.
  • A valid driver’s license may be required at the time of appointment and employees may
    also be required to drive their own car, provide proof of car insurance, and a DMV
    clearance. Individuals who do not meet this requirement due to a disability will be
    reviewed on a case-by-case basis.
  • Position may require pre-employment drug testing, physical examination, and
    fingerprinting for a background investigation.
  • Government agencies accessing US government information, which include federal tax
    information must ensure that background investigation requirements for all agency
    employees and contractors that have access to federal tax information are consistent to
    the IRS background investigation requirements for access to federal tax information. A
    background check may be required if the position requires access to these types of
    records. Background requirements consist of three components which include,
    fingerprinting, citizenship verification and local law enforcement checks. State agencies
    must conduct investigation during time of hire and ensure a reinvestigation is conducted
    10 years from the date of the previous background investigation for each employee that
    has access to federal tax information.

Minimum Education and Experience

Minimum Months of Experience: 12
Education Required: High School
Driver's License Required: Yes
Hiring Requirements for This Job:
  • Drug Testing / Screening
  • Background Checks
  • Reference Check
  • Minimum Hourly Wage: 16.72
    Maximum Hourly Wage: 22.56
    Accessible by Public Transportation: Yes