PA MMES

Job Title: Bilingual Medicare/Medicaid Eligibility Specialist

Date: January 2026

Reports to: Team Leader

Department(s): Premium Assist

FLSA Classification:

Non-Exempt/ Hourly

Location of Position: Remote

Location of Manager: Remote

Travel Required: None

Job Summary: The Bilingual Medicare/Medicaid Eligibility Specialist advocates and assists low-income Medicaid beneficiaries apply to and requalify for government assistance programs. The Bilingual Medicare/Medicaid Eligibility Specialists must build trusting relationships with members and their families to provide critical application assistance. This role is required to provide exceptional customer service, offer member support, and address questions related to the programs associated with our member screening. This role also requires Spanish speaking and writing proficiency and is a 95% phone-based role.

Key Responsibilities:

• Regularly utilize bilingual (Spanish) skills to communicate with members.

• Place and receive calls via a computer interface to conduct telephonic outreach and screening for members who must apply or recertify and are potentially eligible for Medicaid and State Children’s Health Insurance Programs (SCHIP).
• Promote company services and gain cooperation from the health plan members or the head of household. The associate will also capture personal/sensitive, financial information to accurately determine eligibility for various government programs.
• Utilizes the computer system to accurately complete the screening for account eligibility and disposition the account in a timely manner as required.
• Compile, record, and evaluate personal and financial data to verify completeness and accuracy.
• Interpret and explain information such as eligibility requirements and application details.
• Utilizes the computer system to accurately complete the screening for account eligibility and disposition the account in a timely manner as required.
• Initiate procedures to refer customers/members to other agencies for assistance as appropriate. Assists members and collaborates with government agencies to accurately complete the benefit application submission and recertification process following eligibility screening.
• Secures documentation for Medicaid/SCHIP renewal applications if needed for members.
• Attention to detail by adhering to state requirements and securing supporting documentation.
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation.
• Successfully reach quality standards by ensuring proper phone etiquette and adherence to scripts.
• Participates as required in operational development programs.
• Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicaid and SCHIP Enrollment programs.
• Demonstrates behaviors, actions, and attitudes that reflect our vision, mission, and values
• Prepares for and participates in all appropriate meetings.
• Performs miscellaneous administrative tasks as required.
• Provide peer coaching and support to team members as needed. 
• Assist with training sessions or onboarding activities when requested by leadership.
• Other duties as assigned.

Required Knowledge and Skills:

• Requires Spanish speaking and writing proficiency
• Strong working knowledge of Microsoft Products, Windows, Word, Excel, Outlook, TEAMS /technology focused
• Basic Medicare/Medicaid/Healthcare background
• Basic knowledge of government programs and associated eligibility requirements 
• Ability to analyze and interpret governmental program criteria.
• Must be able to navigate through multiple databases/monitors.
• Familiar with commonly used concepts, practices, and procedures within government health care programs
• Ability to manage high call volume.
• Familiar with auto dialing systems.
• Strong telephone, analytical, and interpersonal skills
• Strong Organizational, Problem-Solving, Decision-Making skills
• Strong Conflict management
• Excellent customer service/phone voice skills
• Strong time management skills/ability to meet deadlines
• Strong change management skills
• Strong logical reasoning skills and critical thinking skills
• Strong data entry skills
• Ability to manage multiple priorities simultaneously

Education, Certification, and Experience:

Required:

• 2+ years of experience in the related field

Preferred:

• Associate degree / equivalent professional experience will be considered in lieu of a degree

Attributes:

• Strong ability to persuade or influence
• Strong Communication Skills
• Active Listener
• Detail Oriented
• Compassionate
• Assertive
• Shows Initiative
• Goal/Action Oriented
• Strong Work Ethic

Physical Demands:

• Sitting, Typing, Talking, Hearing/Listening

Security Roles and Responsibilities:     

Centauri’s associates are granted access to information resources to facilitate their responsibilities. All associates must understand and agree to their Information security roles and responsibilities before accessing any of Centauri’s information systems. It is the responsibility of every associate to ensure the safety and confidentiality of data and systems by adhering to the organization’s information security policies and immediately reporting any possible security violations. All associates are required to read, understand, and agree to abide by Centauri’s corporate security policies. Centauri’s associates must only access data they are authorized to access. Depending on role designation, associates may be required to take additional role-based information security training. In addition, associates must successfully complete annual security and compliance refresher training.  Associates will be held accountable for violations of security policies.