About this role
OPEN TO INTERNAL APPLICANTS ONLY
Applications will be accepted until: 9/28/26
Interview Dates will be determined at a later date.
JOB SUMMARY:
A Lead Eligibility Worker is a skilled technical person, with comprehensive knowledge of financial assistance programs, responsible for training other eligibility workers, assigning and reviewing work, and assisting the Financial Assistance Supervisor, as needed. A Lead Eligibility Worker is also responsible for the initial and ongoing eligibility and issuance of benefits for financial assistance programs and services. The Lead Eligibility Worker communicates program requirements, assists in understanding eligibility provides education, makes appropriate referrals to other community resources, and ensures the integrity of the financial assistance programs and services. Work may include helping Eligibility Workers with complex or disputed cases. The Lead Eligibility Worker also tracks and prepares responses to laws or rule changes, subject to guidance from the Financial Assistance Supervisor.
ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE THE FOLLOWING. OTHER RESPONSIBILITIES AND DUTIES MAY BE ASSIGNED.
Administer Complex Eligibility Determination for Federal and State Public Assistance
• Conducts complex case evaluations and extensive personal interviews with clients to assess eligibility.
• Explains application procedures to individuals or groups and answers questions on completing application forms.
• Determines eligibility and recertification of benefits for financial assistance programs according to federal, state, and local laws, policies, and procedures.
Provide Case Management.
• Maintains complete and accurate records on client's eligibility for all assigned programs to meet state and federal requirements of Department of Human Services Quality Control and Program Compliance Audits.
• Communicate client changes that are considered vital to appropriate staff.
• Informs clients of eligibility status refers to programs and other community resources, guides to self-support.
• Composes correspondence and constructs reports.
• Resolve Income Eligibility Verification System, PARIS, and New Hire matches timely. Adjust the benefit amount or close the case.
• Authorize, educate, and enforce the county healthcare access plan.
• Assists clients in resolving health plan problems, investigating issues, and providing resolution.
• Impose sanctions or disqualifications for clients out of compliance.
• Determine Cost Effective Insurance by analyzing health insurance policies.
• Prepare and participate in Appeal Hearings and complete case action as needed.
• Identify potential fraud, provide data and information to Law Enforcement and County Attorney's Office, and prepare administrative disqualification or prosecution cases.
• Recreate budget to determine overpayments and authorize recoupment of funds.
Administrative Duties.
• Research and interpret policies and regulations established by legislative statutes and Department of Human Services rules to determine eligibility.
• Submit Policy Interpretations to DHS per specific incidents and modify procedures accordingly.
• Onboard Eligibility Workers in regard to policy and procedures.
• Provide input into developing and evaluating policies, programs, and procedures.
• Clarify and explain information on financial programs to other agency staff, County Board, clients, potential clients, attorneys, authorized representatives.
• Participate in professional staff development, training sessions, and meetings to remain current regarding legislative, policy, and procedure changes in public assistance program requirements.
• Represent agency at the request of the agency Director or County Board.
• Troubleshoot system problems or system results.
• Assist staff with complex cases in determining eligibility.
• Provide input to financial assistance supervisor on performance reviews of staff.
• In the absence of the Financial Assistance Supervisor, assist with county burial applications, and attend appeal hearings.
• Serve as Mentor for MAXIS and METS with Super User security access in METS.
• Review the work of eligibility workers, including review of case files, at minimum monthly.
• Review complex appeal hearing documents for other Eligibility Workers.
• Other duties and special projects assigned.
FREEDOM TO ACT AND PROBLEM SOLVING
According to local, state, and federal regulations, Lead Eligibility Worker is responsible and accountable for eligibility determinations for various financial assistance programs. The Lead Eligibility Worker must accurately interpret and apply policy and procedures outlined in multiple manuals, DHS bulletins, and statutes. Lead Eligibility Worker must exercise professional judgment, critical thinking, and in-depth analysis of information collected from clients and data sources to ensure program integrity. Lead Eligibility Worker is responsible for prioritizing and organizing tasks to achieve performance standards. The Lead Eligibility Worker has the freedom to make eligibility decisions for all financial assistance programs and collaborates with the financial assistance supervisor on complex cases and policies.
JOB RELATIONSHIPS:
Internal interactions with: collaborates with all departments/staff within Human Services.
External interactions with: Community Partners, Attorneys, Department of Employment and Economic Development, Workers Compensation, medical providers, Public Health, court services, law enforcement, Social Security Administration, Internal Revenue Service, financial institutions, employers, employment services, community action partnerships, housing agencies, schools, other local and state agencies.
QUALIFICATION REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: Requires considerable successful experience as an Eligibility Worker, typically three or more years, and thorough knowledge of programs administered. Leadership training is preferred.
Language Skills: Ability to read, analyze and interpret diversified, complex data, legal documents, IRS forms, insurance information, technical procedures, government regulations, etc. Ability to write reports, business correspondence, and policy/procedure manuals. Ability to write effectively, interview clients, present information, and respond to questions from managers, consumers, and the public. Multilingual skills are beneficial.
Mathematical and Computer Skills: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to use state and county computer systems. (e.g., Microsoft Office, MAXIS, MMIS, METS, PRISM, ISDS, SIR, EDMS, AVS, SMI, DEED, WF1, and Bluezone Scripts). Ability to use/operate office equipment such as computer, telephone, fax machine, copier, printer, scanner, and miscellaneous department tools and equipment.
Reasoning Ability: Considerable ability to solve complex problems and deal with varied situations where only limited standardization exists. Ability to interpret a variety of complex policy and procedures furnished in written, oral, diagram, or schedule form. To remain objective and non-judgmental and complete work accurately and timely according to state and federal regulations. Ability to handle confidential information and follow data practices requirements. Ability to thrive in ambiguous, fast-paced, demanding, and constantly changing work environments while maintaining strong critical thinking, communication, and organization skills.
Employee is responsible and accountable for eligibility and benefit/grant decisions daily. The ability to correctly assess and utilize federal, state, and local dollars to prevent lost revenues and federal sanctions. The agency encourages employees to look for creative means to improve service delivery. Employees' professional knowledge and judgment are relied on heavily by the Agency.
Physical Demands:
The physical demands here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands in this job typically require sitting, walking, standing, driving, talking, hearing, typing, repetitive movement, and seeing. There is exposure to computer keyboards and computer screens. The employee must occasionally lift and move up to 20 pounds. This job's specific vision abilities include close vision, distance vision, and color vision.
Work Environment:
The work environment characteristics described here represent those an employee encounters while performing this job's essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
There is exposure to hostile, despondent, or uncooperative persons, which may result in exposure to offensive language and mental stress and effort. The ability to assess and diffuse these situations is essential.
This position works under great attention to detail and deadlines.
This position requires dealing with clients having numerous needs and substantial personal challenges.
The noise level in the work environment is usually moderate.