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Eligibility Manager Jobs (NOW HIRING)

This position plans, organizes and manages the day-to-day operations of the Eligibility Division, comprised of several levels of eligibility technicians with responsibility for assessing and ...

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 ...

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.

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 ...

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.
More about Eligibility Manager jobs
What cities are hiring for Eligibility Manager jobs? Cities with the most Eligibility Manager job openings:
What are the most commonly searched types of Eligibility jobs? The most popular types of Eligibility jobs are:
What states have the most Eligibility Manager jobs? States with the most job openings for Eligibility Manager jobs include:
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.

$34.52 - $37/hr

Other

Posted 5 days ago


Job description

Job Application Fairness Act In accordance with CO SB23-058, applicants understand that La Plata County will not request or require the applicant to include their age, date of birth, or date of attendance/graduation date on the initial application. Applicants understand that La Plata County can request or require an individual to provide documentation including copies of certification, transcripts, and other materials created by a third party. The applicant understands that the applicant can redact, if they so choose, information that identifies age, date of birth, or dates of attendance/graduation from an educational institution on those requested/required certification, transcripts and other materials created by a third party.

Equal Employment Opportunity La Plata County is proud to be an Equal Opportunity Employer and is committed to the full inclusion of all qualified individuals. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status, or any other protected status in accordance with applicable law. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process and/or to perform essential job functions where the requested accommodation does not impose an undue hardship.

If you have a disability and require a reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your request to HRHelpDesk@lpcgov.org. * * * * * * * * * This job description is not intended to be a comprehensive list of activities, duties or responsibilities for this job. The duties, expectations and actions listed for this role may change at any time with or without notice

* * * * * * * * * Job Summary Join our innovative and dynamic team. This position manages and provides support for state and federal programs, including SNAP, Medical Assistance, Colorado Works, Adult Financial, and CCCAP. Must have knowledge of Colorado rules and regulations related to public assistance programs & recent experience in CBMS.

Experience in personnel management, developing & implementing procedures based on laws, rules, & policies, and responding to crisis situations preferred. Job duties include supporting new and experienced eligibility technicians, collaborating with other unit managers and trainers, completing thorough case reviews, and monitoring and enforcing state deadlines. Flexibility, ability to multitask, excellent time management and computer skills are required.

This position plans, organizes and manages the day-to-day operations of the Eligibility Division, comprised of several levels of eligibility technicians with responsibility for assessing and determining eligibility of clients for various human services programs as well as monitoring clients completing work-force activities, a training unit, and a claims/fraud unit; participates in preparation of annual budget for division; prepares reports on division activities; develops and implements revisions to programs offered based on new or revised rules, laws or regulations; collaborates with outside agencies to enhance delivery of services to clients. Essential Job Functions Essential functions may include any of the following tasks, knowledge, skills and other characteristics. The list that follows is not intended as a comprehensive list; it is intended to provide a representative summary of the major duties and responsibilities.

Incumbent(s) may not be required to perform all duties listed, and may be required to perform additional, position-specific tasks. Reasonable accommodations, as defined under the American with Disabilities Act, will be made when possible. Plans, organizes and supervises employees in the day-to-day operations of the Eligibility Division; supervises overall work performance and daily activities of employees; provides training and review of work; interviews and makes hiring decisions; conducts performance appraisals and related management actions.

Plans long-range goals and objectives for the division. Provides information, advice, feedback, or assistance to others within the department to refine work outputs or resolve problems. Collaborates with community agencies to share information and to provide services and benefits to eligible individuals in an efficient manner.

Monitors monthly, weekly, and daily distribution of work to insure state required timeliness as well as county level goals are met. Monitors case load distribution, work activities, monthly federal participation rate, and makes recommendations for changes when needed. Authorizes cash payments to clients, supportive services monies and diversion grants.

Ensures that work is in compliance with all state and county rules, regulations, policies and procedures. Keeps current on new and revised federal, state and county policies and procedures; develops and implements changes as needed to ensure division is following most recent requirements. Schedules meetings with other department members to exchange information on issues of concern to the entire department and to coordinate services and functions of the agency.

Participates in annual budget preparation; provides recommendations regarding division needs. Maintains records and files; prepares statistical and other reports as required. Maintains and upgrades professional knowledge, skills, and development by attending seminars and training programs and reading trade and professional journals and publications.

Performs other related duties as assigned. Regular and predictable attendance is required. MATERIAL AND EQUIPMENT USED: Computer(s) General Office Equipment Calculator Copier Printer Shredder Minimum Qualifications Required Education and Experience: Bachelor's degree from an accredited four-year college or university in Social Work, Psychology or a related field; and, Five years of progressively responsible related experience; or Any combination of education, training and experience which provides the required knowledge, skills, and abilities to perform the essential functions of the job.

Licenses and Certifications: None. Knowledge, Skills and Abilities Knowledge of: Administrative principles and practices, including goal setting and implementation. Administration of staff and activities, either directly or through subordinate supervision.

Budgetary principles and practices. Community resources available to assist clients. Recordkeeping, report preparation, filing methods and records management techniques.

Correct English usage, including spelling, grammar, punctuation, and vocabulary. Policies, procedures, philosophies, rules and regulations governing the services to clients. Applicable state, federal and local ordinances, laws, rules and regulations.

Methods and techniques of research, statistical analysis and report presentation. All computer applications and hardware related to performance of the essential functions of the job. Skill in: Using interviewing techniques.

Using tact, discretion, initiative and independent judgment within established guidelines. Preparing clear and concise reports, correspondence and other written materials. Organizing work, setting priorities, meeting critical deadlines, and following up on assignments with a minimum of direction.

Applying logical thinking to solve problems or accomplish tasks; to understand, interpret and communicate complicated policies, procedures and protocols. Using a computer to accurately and rapidly enter and retrieve data and information. Using mathematics.

Communicating clearly and effectively, both orally and in writing. Planning, organizing, assigning, directing, reviewing and evaluating the work of staff. Selecting and motivating staff and providing for their training and professional development.

Ability to: Ability to respond to each client with empathy and respect. Ability to de-escalate and manage crisis situations. Ability to establish and maintain effective working relationships with a variety of individuals.

Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to analyze complex problems and develop appropriate solutions. Ability to read, analyze and interpret professional periodicals and journals, technical procedures and government regulations.

Non-Discrimination and EEO Statement La Plata County prohibits discrimination against or harassment of any person employed or seeking employment with La Plata County on the basis of race, color, religion, sex (including pregnancy), age, national origin, disability, veteran status, political affiliation, sexual orientation, gender identity, marital status or genetic information. La Plata County is an equal opportunity employer and assures equal employment opportunities for protected classes, persons with disabilities and for covered veterans. Covered veterans include: special disabled veterans, recently separated veterans, Vietnam era veterans, or any other veterans who served on active duty during a war or in a campaign or expedition for which a campaign badge was authorized.

Inquiries regarding La Plata County's equal employment opportunity policies may be directed to: Director of Human Resources 1101 E 2nd Avenue Durango, CO 81301 Tel: (970)382-6361 Fax: (970)375-7985 Email: HRHelpdesk@lpcgov.org