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Eligibility Specialist: Job Description, Duties and Requirements

Eligibility specialists determine whether or not applicants for various programs meet the necessary qualifications. Usually they work with government aid, especially in the healthcare industry, like Medicare or Medicaid. Their job involves fact checking, record keeping, and advocacy on behalf of their clients. Education requirements vary, but good communication and computer skills are essential.

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Job Description

Eligibility specialists assess whether or not individuals qualify for various programs. Typically these programs offer financial aid from the government, especially in the healthcare industry. Eligibility specialists may work with Medicare or Medicaid, disability claims, or other government-sponsored programs.


The primary task of an eligibility specialist is to review applications for various aid programs and ensure that applicants are eligible for them. This entails verifying that any application forms have been filled out correctly and checking the information on the forms for accuracy. This may require specialists to follow up with applicants a number of times.

In general, specialists engage in a lot of communication with applicants for aid programs. In addition to fact-checking, they can act as an information resource to people who need financial assistance. They may even play the role of counselor or advocate by advising people on what aid programs may benefit them and then helping them receive that benefit.

A large part of eligibility specialists' jobs include documentation and paperwork as well as computerized record keeping. In addition to preparing and maintaining client files, they must keep track of client appointments and any changes in the policies of their organization.


Job requirements for eligibility specialists vary depending on the type of work one does. For eligibility 'fact checkers' who comb over paperwork looking for errors, a high school diploma may be the sufficient educational qualification. For specialists who involve themselves in more of the application process as an advocate or counselor, an associate's or bachelor's degree may be necessary. Future eligibility specialists might study business management. The curriculum teaches them the skills required to operate a business, such as marketing, public relations, and human resources. They could also earn a degree in social work, which studies how to improve a person's well being through socioeconomic institutions and policies.

Beyond education, many employers require their eligibility specialists to have work experience in their industry and a familiarity with its institutions and policies. Given the record keeping nature of the job, basic computer proficiency is also required. Finally, bilingualism may be helpful as eligibility specialists may have significant dealings with non-English speakers.

Salary Info and Job Outlook

According to, most eligibility specialists earn between $24,990 and $48,231 a year, as of December 2013. The U.S. Bureau of Labor Statistics (BLS, reported in May 2012 that the median annual salary earned by eligibility interviewers for government-funded programs was $40,530. Additionally, the BLS indicated that employment of eligibility interviewers working for the government is projected to increase by about ten percent between 2012 and 2022.

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Source: Bureau of Labor Statistics