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Eligibility Representative Jobs (NOW HIRING)

Point32health

Eligibility Representative

Job Summary The MassHealth Eligibility Representative will support the MassHealth Eligibility Assistance Program by providing guidance and enrollment assistance to individuals who may be eligible for ...

Radiology Partners

Eligibility Representative

$18 - $20/hr

General information Press space or enter keys to toggle section visibility Job Title Eligibility Representative Functional Area Teammate - Credentialing/Licensing City Remote Work Location Type ...

radiology partners

Eligibility Representative

$18 - $20/hr

Analyze eligibility trends and communicate findings to leadership to support process improvements and operational performance. * Collaborate with offshore teams and internal partners to improve ...

Radiology Partners

Eligibility Representative

$18 - $20/hr

Analyze eligibility trends and communicate findings to leadership to support process improvements and operational performance. * Collaborate with offshore teams and internal partners to improve ...

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$24.5K

$44.2K

$77K

How much do eligibility representative jobs pay per year?

As of Sep 3, 2026, the average yearly pay for eligibility representative in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

What is an eligibility representative?

An Eligibility Representative is a professional who helps individuals determine their qualification for various government or private assistance programs, such as Medicaid, SNAP, or unemployment benefits. They review applications, collect and verify documentation, and explain program requirements to applicants. These representatives often work for government agencies, healthcare organizations, or insurance companies, ensuring that clients receive the support they are entitled to. Their role requires strong communication, organizational, and analytical skills to navigate complex eligibility criteria.

What are the key skills and qualifications needed to thrive as an eligibility representative?

To thrive as an Eligibility Representative, you typically need strong knowledge of eligibility programs, attention to detail, and at least a high school diploma or equivalent. Familiarity with case management software, data entry systems, and often knowledge of government regulations or benefits programs is important. Excellent communication, problem-solving skills, and empathy help in effectively assisting clients and resolving complex eligibility issues. These skills ensure accurate processing of applications, compliance with regulations, and positive client experiences.

What are some common challenges eligibility representatives face when verifying client information, and how can they address them?

Eligibility Representatives frequently encounter challenges such as incomplete documentation, discrepancies in client information, and navigating complex eligibility criteria. To address these issues, it's important to maintain strong attention to detail, communicate clearly with clients to obtain missing information, and stay up-to-date on changing regulations and program requirements. Collaborating with team members and utilizing available resources, such as eligibility software and policy manuals, can also help resolve issues efficiently and ensure accurate determinations.

What is the difference between Eligibility Representative vs Claims Processor?

CriteriaEligibility RepresentativeClaims Processor
Required CredentialsHigh school diploma or equivalent; some roles may prefer certifications in healthcare or insuranceHigh school diploma or equivalent; certifications in claims processing are a plus
Work EnvironmentOffice setting, interacting with clients and insurance providersOffice setting, reviewing and processing insurance claims
Employer & Industry UsageHealth insurance companies, healthcare providers, government programsInsurance companies, healthcare organizations, third-party administrators
Common Search & Comparison IntentUnderstanding roles related to insurance eligibility and customer serviceDifferences in claims processing and administrative tasks

Eligibility Representatives focus on verifying patient or client eligibility for insurance coverage, often interacting directly with customers. Claims Processors handle reviewing and processing insurance claims after services are rendered. Both roles require similar credentials and work in healthcare or insurance settings, but their primary functions differ in the insurance process.

More about Eligibility Representative jobs

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Cities with the most Eligibility Representative job openings:

What states have the most Eligibility Representative jobs?

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Eligibility Representative jobs near you
Infographic showing various Eligibility Representative job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, and 3% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $44,219 per year, or $21.3 per hour.

Eligibility Representative

DECO Recovery Management

Leesburg, VA • On-site

Full-time

Re-posted 27 days ago

Job description

Company Description

Since 1993, Our team is driven to make the DECO/Elevate PFS Difference each day!  

We believe exceptional efforts produce exceptional results; focusing on a compassionate, empathetic patient-advocacy approach to eligibility services that not only provides hospitals with a targeted revenue flow solution for their uninsured and under-insured populations, but greatly enhances patient satisfaction.

Job Description

JOB SCOPE:

Eligibility Representatives will attempt to perform detailed in-house review, bedside and/or phone interviews to determine if patient is a viable candidate for State, Federal, County, Medical or Disability Assistance, and if so to assist the patient/guarantor with the application process for any Assistance type program. This assistance will include the necessary investigative, field, and administrative work needed to assist the patient in meeting eligibility requirements for Disability, Medicaid or other applicable County, Federal or State programs if appropriate.

JOB RESPONSIBILITIES:
-Screen patients and/or patient's representative to determine potential eligibility for Third Party Resources.
-Explain to patients and other entities the eligibility requirements, application process and verification requirements for applicable programs.
-Facilitate the application process when appropriate for the patient by assisting the patient in completing the application, scheduling appointment interviews and obtaining required verifications.
-Document pertinent patient information in the appropriate systems dictated by the health care facility and DECO/ElevatePFS.

An equal opportunity employer

Qualifications
  • Good customer service skills
  • Basic computer skills
  • Ability to pay attention to detail and great follow through
  • Some DFACS Experience
  • Bilingual Spanish is a plus
Additional Information

All your information will be kept confidential according to EEO guidelines.

Apply