Eligibility Lead

Eligibility Lead

WelbeHealth is a value-based healthcare organization that’s transforming the future of senior care by providing an all-inclusive care option to our most vulnerable senior population.

The Eligibility Lead is accountable for proactively addressing complex eligibility challenges and ensuring seamless participant coverage. This position works directly with CMS, DHCS, and county Medicaid offices to troubleshoot eligibility issues, correct misalignments, and advocate for participants’ eligibility for the PACE program. This role also plays a key part in training internal teams, including Outreach & Enrollment and Social Work, to enhance organizational knowledge and prevent eligibility-related disruptions.

Essential Job Duties:

• Act as the organizational expert in Medicare or Medicaid eligibility policies and keep teams informed of regulatory updates


• Serve as a strategic advisor to executive leadership on eligibility-related risks, trends, and policy implications, shaping organizational strategy and ensuring compliance with evolving federal and state regulations


• Oversee resolution of complex eligibility issues, including coverage misalignments, retroactive enrollments, reinstatements, and eligibility corrections


• Work directly with CMS, DHCS, and county agencies to troubleshoot eligibility discrepancies and secure accurate benefit assignments


• Advocate for participants in disputed eligibility cases to minimize coverage gaps


• Develop and deliver training programs for internal teams to improve eligibility accuracy and efficiency


• Maintain knowledge of repositories, job aids, and process documentation to support staff in handling eligibility cases

Job Requirements:

• Associate’s or bachelor’s degree in relevant field preferred; relevant professional experience may be substituted


• Minimum of five (5) years of experience in Medicaid, Medicare eligibility, or social services


• Minimum of three (3) years of experience in working with governmental agencies; experience working directly with CMS is highly desired


• Excellent leadership, organizational, and communication skills in settings with seniors, their families, and interdisciplinary team members


• Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects

Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• Standard business working hours


• Full medical, dental, and vision insurance, beginning day one


• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days


• And additional benefits

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected]