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Eligibility Manager Jobs (NOW HIRING)

Tidal Basin Holdco, LLC

Eligibility Analyst

Guaynabo, PR · On-site

$20 - $27/hr

The Eligibility Analyst needs to work closely with the Eligibility Manager, the program staff and in collaboration with the subrecipients to reach the goals and objective of the program. Duties and ...

McGregor PACE

Eligibility Specialist

Cleveland, OH · On-site

$20 - $24/hr

Communicate with the Eligibility Manager and/or Team Lead about any delays affecting eligibility. * Keep accurate and detailed notes on correspondence with participants and Medicare/Medicaid agencies.

Trucordia

Billing and Eligibility Representative

Layton, UT · On-site +1

$15.50 - $20/hr

Maintain, update, and manage employee enrollment and eligibility files with accuracy and timeliness. * Process and track eligibility changes, including new enrollments, terminations, qualifying ...

Trucordia

Billing and Eligibility Representative

Layton, UT · On-site

$15.50 - $20/hr

Maintain, update, and manage employee enrollment and eligibility files with accuracy and timeliness. * Process and track eligibility changes, including new enrollments, terminations, qualifying ...

APLA Health

Clinic Manager

Los Angeles, CA · On-site

$30.63 - $38.05/hr

Work in conjunction with the enrollment and eligibility manager to conduct quality assurance audits to ensure registration and eligibility processes are completed according to clinic policies ...

APLA Health

Clinic Manager II

Los Angeles, CA · On-site

$33.23 - $41.67/hr

Work in conjunction with the enrollment and eligibility manager to conduct quality assurance audits to ensure registration and eligibility processes are completed according to clinic policies ...

APLA Health

Clinic Manager II

Los Angeles, CA · On-site

$33.23 - $41.67/hr

Work in conjunction with the enrollment and eligibility manager to conduct quality assurance audits to ensure registration and eligibility processes are completed according to clinic policies ...

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Eligibility Manager information

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How much do eligibility manager jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for eligibility manager in the United States is $22.65, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.96 per hour, depending on experience, location, and employer.

What is the difference between Eligibility Manager vs Claims Specialist?

CriteriaEligibility ManagerClaims Specialist
Required credentialsTypically requires a high school diploma or associate degree; certifications like Certified Eligibility Specialist are commonUsually requires a high school diploma; certifications like Certified Claims Professional are beneficial
Work environmentOffice setting, healthcare or insurance companiesOffice setting, healthcare or insurance companies
Employer and industry usageUsed in healthcare, insurance, government agenciesUsed in healthcare, insurance, and related sectors
Common search and comparison intentUnderstanding roles, responsibilities, and qualificationsUnderstanding differences in claims processing and eligibility

Eligibility Managers focus on verifying patient or client eligibility for services or benefits, ensuring compliance with policies. Claims Specialists handle processing and adjudicating insurance claims, focusing on reimbursement and accuracy. While both roles operate within healthcare and insurance sectors, Eligibility Managers primarily verify eligibility, whereas Claims Specialists manage claims processing.

What are the key skills and qualifications needed to thrive as an Eligibility Manager, and why are they important?

To thrive as an Eligibility Manager, you need expertise in eligibility determination, compliance regulations, and case management, often supported by a bachelor's degree in social work, public administration, or a related field. Familiarity with eligibility management systems, case tracking software, and knowledge of relevant federal and state regulations is typically required. Strong leadership, problem-solving, and communication skills help in managing teams and resolving complex eligibility cases. These competencies are vital for ensuring accurate eligibility determinations, regulatory compliance, and efficient program operations.

What are the most common challenges faced by an Eligibility Manager in ensuring compliance with changing regulations?

Eligibility Managers often encounter challenges related to staying up-to-date with frequently changing federal, state, and local regulations that impact program eligibility criteria. They must ensure that their team is properly trained on new policies and that all documentation and procedures remain compliant. Additionally, balancing high caseloads while maintaining accuracy and timeliness in processing applications can be demanding. Effective communication with both applicants and internal departments is crucial to navigate complex cases and resolve discrepancies efficiently.

What is an Eligibility Manager?

An Eligibility Manager is a professional responsible for overseeing and managing the process of determining if individuals or groups qualify for specific programs, benefits, or services. They typically work for government agencies, healthcare organizations, or insurance companies. Their duties include supervising eligibility staff, ensuring compliance with policies and regulations, and resolving complex eligibility determinations or appeals. Eligibility Managers play a crucial role in making sure that assistance is provided to those who meet the necessary requirements, while preventing fraud and misuse of resources.
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What are the most commonly searched types of Eligibility jobs? The most popular types of Eligibility jobs are:
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Eligibility Manager jobs near you
Infographic showing various Eligibility Manager job openings in the United States as of May 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $47,119 per year, or $22.7 per hour.

Eligibility Analyst

Tidal Basin Holdco, LLC

Guaynabo, PR • On-site

$20 - $27/hr

Full-time

Posted 11 days ago

Job description

Position Summary:
Tidal Basin is actively seeking an innovative, motivated, and talented CDBG DR Eligibility Analyst. The ideal candidates will be able to showcase their technical expertise and project delivery skills in the CDBG DR regulations, policies, and procedures. Eligibility Analysts will be responsible for the FEMA Public Assistance Projects evaluation compliance with the Non-Federal Match requirements from activity eligibility determination to match payment recommendation. The Eligibility Analysts is also responsible for developing project closeout files and packages. The Eligibility Analyst needs to work closely with the Eligibility Manager, the program staff and in collaboration with the subrecipients to reach the goals and objective of the program.
Duties and Responsibilities:
  • Access COR3 and FEMA's systems of record to identify and download all documentation related to the PW evaluation.

  • Identify and record all PW related documentation into the PRDOH system of record, as established in the corresponding procedure.

  • Maintain the established file management structure in order and in compliance with all applicable procedures.

  • Identify, evaluate, and validate the Record of Environmental Consideration among each PW documentation.

  • Complete the required calculations to determine the eligible costs needed to justify the match payment, and confirm the required documentation is available within the PRDOH's system of record.

  • Review and validate the documentation required represents eligible costs to justify the match payment.

  • Review and validate the procurement documentation for each PW to confirm compliance with CDBG-DR and PRDOH requirements.

  • Provide any required support to the Grant Manager's Labor and Civil Rights Compliance team during the labor compliance review process.

  • Review and validate that the Duplication of Benefits requirements are met by the project being reviewed and analyzed.

  • Completes all the eligibility review steps described in accordance with standard operating procedures for a match payment on any given project assigned for review.

  • Prepare and submit to the Eligibility Manager all required information and documentation to complete the match payment review and further steps.

  • Complete the necessary reviews, including the National Objective determination, for all applicable projects under the Non-Federal Match Program.

  • Complete the preliminary and full evaluations for HMGP projects in means of validating compliance with CDBG-DR requirements.

  • Complete the review and validation necessary to complete the HMGP projects' match application.

  • Provide any necessary assistance for the review and recommendation process, or any other procedure as required by the Eligibility Manager or Key Staff.

Required Skills and Competencies:
  • High proficiency in Microsoft Suite applications including Excel, Share Point and One Drive.

  • This position requires fluent verbal / written communication skills in English and Spanish.

  • Must be self-motivated, responsible, and confident with a commitment to integrity

  • Must possess high attention to detail, be very organized and able to prioritize multiple projects and meet deadlines.

  • Project management or personnel/team management experience.

  • Prior experience working with CDBG laws, regulation, and policies is a plus.

  • Experience working with FEMA Grants Portal, COR3 DRS, DRGR, IDIS, or similar systems is a plus.

Require Education and Experience:
  • Must have a bachelor's degree or higher education, including but not limited to Engineering, Architecture, Accounting, Law, or similar studies.

  • Must have two (2) years of experience in auditing federally funded grant program's processes, including but not limited to document and process auditing, policy review and implementation, compliance review, and invoice review and validation.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Rising Phoenix Holdings Corporation is an Equal Employment Opportunity Employer.

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