MassHealth & DSNP Eligibility Specialist (Hybrid)

massgeneralbrigham; Somerville (MA); Hybride; USD 55 000 - 70 000; Plein temps

Résumé du poste

Mass General Brigham Health Plan is seeking an Enrollment Specialist to help MassHealth applicants navigate the enrollment process in a hybrid role based in Somerville, MA. You will outreach to Dual Eligible prospects, explain eligibility requirements, and guide them through forms and steps, collaborating with sales and external brokers as needed.

The ideal candidate has MassHealth application experience, 2–3 years in sales/healthcare/insurance, and strong communication skills in English

Qualifications

• At least 2–3 years of experience in sales, healthcare, or insurance with a focus on Government Markets.
• At least 1–2 years of experience with MassHealth Eligibility and Application Process preferred.
• Bilingual (Spanish/English) preferred.
• Familiar with HIPAA and healthcare regulations to ensure compliance.
• Experience with call center tools and CMS/state guidelines is a plus.

Responsabilités

• Analyze prospect eligibility related to Medicaid and Medicare enrollment.
• Keep up to date on Medicaid and Medicare requirements.
• Work with SCO & One Care prospects identified for enrollment with MGBHP.
• Deliver an exceptional prospect experience via telephonic and written outreach.
• Assist prospects with the Medicaid & Medicare process by explaining eligibility requirements and forms.
• Collaborate with internal team and external brokers to manage pipeline cases.
• Identify process bottlenecks and suggest improvements to enrollment workflows.
• Support policy and workflow documentation to ensure regulatory compliance.
• Monitor and document member outreaches in the CRM system.

Connaissances

Bilingual Spanish/English

MassHealth experience

Customer service

Regulatory knowledge

Travel ability

CMS guidelines familiarity

Formation

High School Diploma or Equivalent

Outils

CRM software

Call center software

Description du poste

Mass General Brigham Health Plan is seeking an Enrollment Specialist to help MassHealth applicants navigate the enrollment process in a hybrid role based in Somerville, MA. You will outreach to Dual Eligible prospects, explain eligibility requirements, and guide them through forms and steps, collaborating with sales and external brokers as needed.

The ideal candidate has MassHealth application experience, 2–3 years in sales/healthcare/insurance, and strong communication skills in English