Eligibility Representative

Benefits and Eligibility Representative

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 Mass Health 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 Mass Health 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.

To Apply:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About Mass Health:
Mass Health 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, Mass Health works to improve health outcomes, reduce disparities,…