Benefits and Eligibility Representative

Commonwealth of Massachusetts•Worcester, MA

11d•Onsite

About The Position

MassHealth Operations (MHO) seeks a customer service-focused Benefits and Eligibility Representative to work in a fast-paced call center environment. The representative uses technology and client management software to review, evaluate, and determine applicant eligibility for medical assistance in accordance with MassHealth policies and procedures, while maintaining direct contact with clients. The position involves interviewing benefit applicants, helping them complete eligibility forms and submit required verifications, and evaluating documents for people under age 65 who live in the community. The representative gathers and verifies demographic, financial, and other information; updates eligibility records; reconciles case information with other agencies and sources; responds to member inquiries; explains eligibility rules and appeal procedures; and represents the agency at hearings by preparing and delivering explanations of eligibility determinations. The selected candidate must work in person at the office five days per week for the first nine months. A hybrid schedule may be considered after successful completion of that period. The minimum entrance requirement is two years of full-time or equivalent part-time qualifying professional or paraprofessional experience, with specified education substitutions. Travel may be required based on assignment.

Requirements

Active listening and the ability to ask appropriate questions.
Ability to follow rules correctly and arrange information or actions in the required order.
Ability to understand information and ideas.
Ability to communicate information and ideas clearly, verbally and in writing.
Ability to read and understand written information.
Ability to evaluate information against standards and verify its accuracy.
Ability to identify the nature of problems.
Adaptability and flexibility in response to change and workplace variety.
Attention to detail and thoroughness in completing work tasks.
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; education toward a degree is prorated based on completed requirements, and one year of education equals 30 semester hours.
Based on assignment, travel may be required. Employees who choose to use a motor vehicle for travel must have a current and valid Massachusetts Class D driver's license or equivalent from another state.
Must report to the office in person five days per week during the first nine months of employment.

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 demonstrated ability to identify and solve problems.
Active-listening skills and the ability to ask 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, assist them with eligibility forms, and help them submit required verifications to obtain and validate demographic and financial information.
Evaluate submitted documents from individuals under age 65 living in the community for accuracy and completeness to support initial and continued eligibility determinations for MHO-administered programs.
Contact applicants to obtain information missing from eligibility forms, contact collateral information sources, and determine immigrant status.
Review electronic documents and updated demographic, financial, and background data; update member eligibility records 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 about eligibility requirements.
Explain appeal rights, eligibility rules, and procedures to customers, applicants, attorneys, advocates, providers, public officials, external agencies, members of the public, and other parties.
Represent the agency at hearings by preparing and delivering explanations of eligibility determinations.