Benefits and Eligibility Representative-Quincy

Commonwealth of Massachusetts•Quincy, MA

11d•Hybrid

About The Position

MASSHEALTH Operations (MHO) is seeking a customer service-focused professional to determine applicant eligibility for medical assistance in accordance with MassHealth policy and procedures. The role is based in a productive, fast-paced call center and uses technology and client management software to review and evaluate applications. The successful candidate will work directly with clients and demonstrate strong customer service skills. The selected candidate must report in person to the office five days per week during the first nine months of employment. A hybrid schedule may be considered after successful completion of that period. Depending on assignment, travel may be required. MassHealth is the Commonwealth's Medicaid and Children's Health Insurance Program, serving approximately two million Massachusetts residents. It works with providers, health plans, community organizations, and government agencies to improve health outcomes, reduce disparities, strengthen care coordination, and ensure access to high-quality, person-centered care. Before hire, the recommended candidate will undergo a criminal and tax history background check, and education, licensure, and certifications will be verified. Education and license/certification information provided by selected candidates may be published on the Commonwealth's website under the Massachusetts Public Records Law. Salary placement depends on related experience and education and the applicable compensation structure; bargaining-unit compensation is subject to the relevant collective bargaining agreement.

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.
A bachelor's or higher degree may substitute for required experience at a rate of two years of education for one year of experience. One year of education equals 30 semester hours, and partially completed degree education is prorated.
Ability to actively listen and ask appropriate questions.
Ability to follow rules correctly to arrange information or actions in the required order.
Ability to understand information and ideas.
Ability to communicate information and ideas clearly to others.
Ability to read and understand written information.
Ability to communicate information and ideas effectively in writing.
Ability to evaluate information against standards and verify its correctness.
Ability to identify the nature of problems.
Openness to change and variety in the workplace.
Careful attention to detail and thorough completion of work tasks.
Must report to the office in person five days per week for the first nine months of employment.
Based on assignment, travel may be required. Employees who choose to use a motor vehicle for travel must have a current, valid Massachusetts Class D motor vehicle operator's license or equivalent from another state.

Nice To Haves

Detail-oriented and highly organized, with the ability to multitask and navigate a computer while on the phone.
Strong communication and customer service skills, with the ability to identify and solve problems.
Skilled in active listening and asking questions when appropriate.
Sound judgment and composure in difficult situations.
Strong attention to detail and ability to evaluate and verify information against standards.
Proficiency with Microsoft Office products, including Outlook, Word, and Excel.

Responsibilities

Interview people requesting benefits, help them complete eligibility forms, and submit required verifications to obtain and validate demographic and financial information.
Evaluate documents submitted by people under age 65 who live in the community to ensure accuracy and completeness and support initial and continued eligibility determinations for MHO programs.
Contact applicants to obtain information missing from eligibility forms, contact collateral sources, and determine immigrant status.
Review electronic documents and updated demographic, financial, and background data for member eligibility updates, making necessary corrections.
Reconcile MHO case information with information from other agencies and sources to verify continued benefit eligibility.
Respond to member inquiries and provide information about eligibility requirements.
Explain appeal rights, eligibility rules, and procedures to customers, applicants, attorneys, advocates, providers, public officials, external agencies, the public, and other parties.
Represent the agency at hearings by preparing and delivering explanations of eligibility determinations.