Eligibility Specialist - Medicaid

Position: Eligibility Specialist - Medicaid

Location: US-TX-Bellaire

Shift: 8a - 5p

About Texas Children's Hospital

Texas Children’s Health Plan (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org


We are searching for an Eligibility Specialist - someone who works well in a fast-paced setting. In this position, you’ll ensure that member eligibility data is accurate and complete by auditing, validating, reconciling, and updating the data in the claims processing system. You will research and resolve member eligibility issues and occasionally collaborate with other business partners and vendors and ensure there is a timely response to any member eligibility inquiries from internal and external stakeholders.


Think you’ve got what it takes?

Responsibilities :

  • Audit, validate, and reconcile member eligibility data in the claims processing system to ensure it matches the data received from the state
  • Manually update member eligibility data using multiple sources for reference and ensuring that it is processed in accordance with our policies and procedures
  • Partner with business partners to research and resolve member eligibility issues as needed
  • Collaborate with the vendors and the state to resolve issues
  • Address issues that are submitted via the eligibility group email boxes, Macess service forms, and reports submitted via a secure FTP site
  • Review and respond to member eligibility inquiries within established time frames


  • High school diploma or GED
  • Bachelor’s degree in health care administration, business administration, information systems, or a related field preferred (can also substitute for 4 years’ experience)
  • 4 years’ experience in member eligibility and/or enrollment required
  • 2 years’ experience in health plans or managed care operations required
  • 2 years’ experience with Texas Medicaid rules and regulations preferred

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