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Eligibility Representative information

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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

What cities are hiring for Eligibility Representative jobs?

Cities with the most Eligibility Representative job openings:

What states have the most Eligibility Representative jobs?

States with the most job openings for Eligibility Representative jobs include:

What job categories do people searching Eligibility Representative jobs look for?

The top searched job categories for Eligibility Representative jobs are:

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.

Outpatient Medicaid Eligibility Representative

Revenue Group

Cleveland, OH • On-site

$13.50 - $14.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Key responsibilities

  • Screen and interview patients to determine insurance eligibility via outbound calls.

  • Provide accurate documentation of eligibility assessments and work towards meeting quality and productivity goals.

  • Participate in training on HIPAA regulations, Medicaid procedures, and client systems to perform job responsibilities effectively.

Job description

Description:

Start Date: Immediately

Pay: $13.50-$14.50 an hour based on experience plus monthly bonus up to $300 after 90 days

Hours: Monday - Friday 8:00am – 4:30pm (With a half hour lunch) and 2 company paid 15 min breaks

*This position is remote upon completion of 4 weeks of training on site in Cleveland office! *

**You MUST have internet speed of 100MBps**


Who is Hospital Referral Services?
No one wakes up in the morning and says, "Today I want to go to the hospital". We are here to help when the unexpected happens. Hospital Referral Services Hospital Insurance Representative will help patients via phone to see what assistance programs the uninsured or underinsured may be eligible to receive.
We are looking for self-motivated professional to add to our growing team. If helping people is something you enjoy, this may be the right job for you.


HRS's team of experts helps guide patients through the Medicaid process so the patient can focus on recovery.


Our employees voted us Top Workplaces 5 years in a row!


The Outpatient Medicaid Eligibility Representative will be responsible for:

  • Screening/Interviewing patients for insurance eligibility in outbound dialer environment
  • Providing thorough, efficient, and accurate documentation.
  • The Outpatient Medicaid Eligibility Representative is responsible for meeting goals and quality standards through efficient and accurate work activities.

PM21

Requirements:

Work Requirements:

  • 1-3 years Dialer call center environment preferred – not required (minimum of 60 calls daily)
  • 1-3 years of previous healthcare eligibility experience preferred-not required
  • Ability to maintain the highest level of confidentiality, customer service, and knowledge of HIPAA.
  • Proficient personal computer skills including Microsoft Office – able to type at least 40 WPM
  • The Outpatient Medicaid Eligibility Screener must have the ability to multi-task and have good time management skills.
  • High School Diploma or equivalent (GED)
  • 7-year background check

Training for the Outpatient Medicaid Eligibility Representative:

  • In office training will include HIPAA regulations, Revenue Group procedures, Medicaid eligibility, role-playing, client systems and procedures.
  • In office floor training: This will include observation of veteran representatives and supervised calls.

Our Benefits:

  • 100% Paid Training
  • 401(k) matching
  • Paid Time off (PTO) – Up to 10 days your first year!
  • 8 Paid Holidays – Including your birthday!
  • Referral Program
  • Employee Assistance Program (EAP)
  • Growth & Continued Training
  • Dental & Vision insurance
  • Health insurance (including Long & Short-Term Disability)
  • Life insurance (Company Paid)

EEO Statement:
We are an Equal Employment Employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state/province, or local laws.


PM21