Benefits and Eligibility Representative

Commonwealth of Massachusetts

Worcester (MA)

On-site

USD 66,000 - 90,000

Full time

4 days ago

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Job summary

MassHealth Operations is seeking a Benefits and Eligibility Representative to join a fast-paced call center environment. The role evaluates and determines applicant eligibility for medical assistance, handling documentation, inquiries, and eligibility updates in line with MassHealth policy.

The successful candidate will report in-person five days a week for nine months; a hybrid schedule may be considered thereafter. Strong customer service and attention to detail are essential.

Qualifications

MINIMUM ENTRANCE REQUIREMENTS: At least two years of full-time, or equivalent part-time, professional or paraprofessional experience in social work or related fields.
SUBSTITUTIONS: A Bachelor’s or higher degree may substitute for required experience at two years of education per one year of experience.
LICENSES: Travel may be required; valid Massachusetts driver’s license if travel is assigned.

Responsibilities

Interview applicants for benefits and help complete eligibility forms and verifications.
Evaluate documents to determine initial and continued eligibility for MassHealth programs.
Contact applicants and collateral sources to obtain missing information and determine immigrant status.
Review updated demographic and financial data for eligibility updates.
Explain eligibility rules, appeal rights, and procedures to customers and external parties.
Represent the agency at hearings and prepare explanations of determinations.

Skills

Active listening

Information ordering

Comprehension

Expression

Written comprehension

Written expression

Evaluating information

Problem identification

Adaptability & flexibility

Attention to detail

Job description

An Official website of the Commonwealth of Massachusetts

Job Description - Benefits and Eligibility Representative (2600076P)

Job Description

Benefits and Eligibility Representative - ( 2600076P )

MASSHEALTH Operations (MHO) is seeking a dynamic customer service-focused professional for the role of Benefits and Eligibility Representative. The selected candidate will work in a productive, fast-paced call center environment, utilizing technology and client management software to review, evaluate and determine applicant eligibility for medical assistance in accordance with MassHealth policy and procedures. Ideal candidates will display exceptional customer service and demonstrate an ability to successfully navigate a direct client-contact relationship.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

Interview those requesting benefits; help them complete eligibility forms and submit required verifications in order to obtain and validate demographic and financial information.

Evaluate submitted documents from those individuals under age 65 living in the community to ensure accuracy and completeness and to support the initial and continued determination of eligibility for programs administered by MassHealth Operations (MHO).

Contact applicants to obtain information not listed on eligibility forms, contact collateral sources of information, and determine immigrant status.

Review electronic documents, updated demographic, financial, and background data for member eligibility updates and make necessary corrections.

Reconcile MHO case information with information from other agencies and sources to verify continued eligibility for benefits.

Respond to member inquiries and provide information regarding eligibility requirements.

Explain appeal rights, eligibility rules, and procedures to customers, applicants, attorneys, advocates, providers, public officials, external agencies, the public or other parties.

Represent agency at hearings by preparing and delivering explanations of eligibility determinations.

The selected candidate will be expected to report to the office in-person, five (5) days per week for the first nine (9) months of employment. A hybrid work schedule may be considered at the successful conclusion of this nine-month period.

Required Qualifications:

Active listening: listening to what other people are saying and asking questions that are appropriate.

Information ordering: following a given rule or set of rules correctly in order to arrange things or actions in a certain order. The things or actions can include numbers, letters, words, pictures, procedures, sentences, and mathematical or logical operations.

Comprehension: understanding information and ideas.

Expression: communicating information and ideas so others will understand.

Written comprehension: reading and understanding information and ideas presented in writing.

Written expression: communicating information and ideas in writing so others will understand.

Evaluating information against standards: evaluating information against a set of standards and verifying that it is correct.

Problem identification: identifying the nature of problems.

Adaptability & flexibility: being open to change (positive or negative) and to considerable variety in the workplace.

Attention to detail: being careful about detail and being thorough in completing work tasks.

Preferred Qualifications:

Detail-oriented and highly organized, with strong ability to successfully multi-task; capacity to navigate a computer while on the phone.

Stellar "soft skills" in communication and customer service with proven capability to identify and solve problems.

Skilled in active listening, while demonstrating the ability to listen to what people say and ask questions when appropriate.

Ability to display sound judgement coupled with maintaining composure in difficult situations.

Strong attention to detail with the ability to evaluate and verify information against a set of standards.

Proficient usage of Microsoft Office products including Outlook, Word, and Excel.

About MassHealth:

MassHealth is the Commonwealth's Medicaid and Children's Health Insurance Program, providing comprehensive healthcare coverage and services to approximately two million Massachusetts residents. Through partnerships with providers, health plans, community organizations, and government agencies, MassHealth works to improve health outcomes, reduce disparities, strengthen care coordination, and ensure access to high-quality, person-centered care. As one of the largest Medicaid programs in the country, MassHealth plays a critical role in advancing healthcare innovation, promoting health equity, and supporting the well-being of individuals, families, and communities across the Commonwealth.

A criminal and tax history background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure, and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

For questions, please contact the Office of Human Resources at 1-800-510-4122 and select option #4.

Qualifications

MINIMUM ENTRANCE REQUIREMENTS: At least two years of full-time, or equivalent part-time, professional or paraprofessional experience in social work or social casework, claims adjudication, job placement, recruitment, employment counseling, vocational or rehabilitation counseling, credit investigation, educational counseling, legal advocacy, or legal counseling.

SUBSTITUTIONS:

A Bachelor's or higher degree may be substituted for the required experience on the basis of two years of education for one year of experience.
One year of education equals 30 semester hours. Education toward a degree will be prorated on the basis of the proportion of the requirements actually completed.

LICENSES: Based on assignment, travel may be required. Those employees who elect to use a motor vehicle for travel must have a current and valid Massachusetts Class D Motor Vehicle Operator's license or the equivalent from another state.

Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

An Equal Opportunity / Affir… Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC)may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Official Title : Ben Elig & Refer Soc Wrk (A/B)

Primary Location

United States-Massachusetts-Worcester-50 Southwest Cuttoff

Job

Community and Social Services

Agency

Exec Office Of Health and Human Services

Schedule

Full-time

Shift

Day

Job Posting