Eligibility Specialist: Job Description, Duties and Requirements

Sep 22, 2019

Eligibility specialist requires little formal education. Learn about the training, job duties and other requirements to see if this is the right career for you.

Depending on an eligibility specialist's responsibilities, they may or may not need to complete a degree program. Eligibility specialists spend most of their work day reviewing, filing, and organizing files and papers, so a sense of organization and attention to detail are extremely important. Eligibility specialists should also be familiar with their employers' policies.

Essential Information

Eligibility specialists determine whether or not applicants for various programs meet the necessary qualifications. Usually they work with government aid, especially in the health care 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.

Required Education High school diploma; associate's degree may be required
Other Requirements Specific training on government-funded programs may be needed.
Projected Job Growth (2018-2028) N/A
Median Salary (2018) $46,020 for eligibility interviewers*

Source: *U.S. Bureau of Labor Statistics

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 health care 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 PayScale.com, most eligibility specialists earn between $28,000 and $54,000 a year, as of September 2019. The U.S. Bureau of Labor Statistics (BLS, www.bls.gov) reported in May 2018 that the median annual salary earned by eligibility interviewers for government-funded programs was $46,020.

Eligibility specialists often work for government programs in reviewing applications, serving as fact checkers or advisors. Computer proficiency is required, and a degree program in social work or business management could provide the skills necessary for the job.

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