Medicaid Eligibility Specialist

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FEDlogic, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2015

🤝 B2B

⚕️ Healthcare Insurance

👥 HR Tech

B2B • Healthcare Insurance • HR Tech

FEDlogic, LLC is a benefits advocacy and consulting company that connects employees and their families with expert navigators of federal and state healthcare and benefit programs. It provides employer-sponsored, unbiased and unlimited education and advocacy for programs such as Medicare, Medicaid, Social Security, disability, Veterans and tribal benefits, helping employees facing major health crises or life changes access more comprehensive and often lower-cost coverage. Founded in 2015, FEDlogic serves employers nationwide, reduces self-insured plan costs, supports HR departments, and specializes in translating complex government benefit rules into actionable guidance for employees.

📋 Description

• Serve as a subject matter expert on Medicaid eligibility rules, including MAGI, ABD, Medically Needy, and waiver programs. • Analyze complex eligibility cases and provide technical assistance to internal and external stakeholders. • Interpret and apply state and federal regulations, CMS guidance, and waiver provisions to real-world eligibility scenarios. • Support system design, testing, and policy implementation related to Medicaid eligibility. • Develop and deliver training and reference materials for eligibility workers, supervisors, and partners. • Assist in quality assurance efforts by conducting case reviews and identifying policy gaps or training needs, when needed. • Liaise with our customers and state and federal agencies on eligibility policy clarifications and updates. • Any other tasks as assigned by Leadership.

🎯 Requirements

• Minimum 10 years of direct experience in Medicaid eligibility determination, policy analysis or training. • Minimum 3 years of customer service, healthcare navigation, benefits administration, or case management experience. • Deep understanding of Medicaid eligibility rules under SSA, CMS, and state-specific implementations. • Demonstrated experience with 1634 and 209(b) state models, spend-down programs and eligibility systems. • Strong analytical and documentation skills and be detail oriented. • Strong writing, communication, and stakeholder engagement skills. • Experience working in a fast-paced, service-oriented environment. • Prolonged sitting and computer work. • Must be able to handle confidential sensitive medical information. • Proficiency with Customer Relationship Management systems (i.e. Salesforce and Tableau), workforce management tools, Google Workplace, Slack and minimal usage of Microsoft Office Suite.

🏖️ Benefits

• Flexible remote work environment • Paid Time Off (PTO) plus all federal holidays off • Comprehensive benefits package with health, dental, vision insurance group term life, short term disability, long term disability and voluntary life plans. • Numerous supplemental plans to assist employees. • Paid maternity, paternity and adoption leave benefits. • Cancer Experts Now - supplemental plan • 401(k) retirement plan with matching contributions. • Supportive and collaborative work environment. • Opportunity to be part of a rapidly growing company dedicated to making a difference in the lives of families.