DSNP MassHealth Eligibility Representative

Mass General Brigham•Somerville, MA

8d•Hybrid

About The Position

The DSNP MassHealth Eligibility Representative assists people with applying for MassHealth for the first time, renewing coverage, or applying for waivers. The role reaches out to Dual Eligible prospects and guides them through the Medicaid enrollment process from start to finish, while also providing Medicare enrollment guidance. The representative monitors and optimizes MassHealth and Medicare eligibility and enrollment processes, working with SCO and One Care prospects who have expressed interest in enrolling with Mass General Brigham Health Plan. Conversions count toward an individual monthly target. The position provides a positive prospect experience through telephone and written outreach, explains eligibility requirements and applicable forms, and coordinates with internal sales representatives, external brokers, and other stakeholders. It also identifies workflow inefficiencies, supports compliant policies and procedures, and documents outreach in the CRM system. This is a full-time hybrid role with a Monday–Friday schedule, generally 8:30 a.m.–5:00 p.m. Eastern Time, and 40 scheduled weekly hours. Work includes remote days, local travel to customer or client accounts and partners, and quarterly in-person team meetings in Somerville, Massachusetts. Remote work requires a stable, secure, quiet, HIPAA-compliant workspace. Reliable transportation is required for local travel.

Requirements

High school diploma or equivalent.
At least 2–3 years of experience in sales, healthcare, or insurance, with a focus on Government Markets.
Familiarity with healthcare regulations, including HIPAA, to ensure compliance and maintain confidentiality.
Familiarity with call center software, customer relationship management systems, and related tools.
Familiarity with CMS and state regulatory guidelines related to Medicare Advantage and DSNP enrollment.
Familiarity with the healthcare industry, hospital operations, and medical terminology.
Familiarity with Dual Eligible products in Massachusetts.
Strong problem-solving skills for escalated or challenging customer interactions.
Commitment to exceptional customer service and positive experiences for patients, visitors, and other stakeholders.
Ability to travel to meet internal and external partners and prospects; reliable local transportation is required.
Ability to work remotely from a stable, secure, quiet, HIPAA-compliant workspace.

Nice To Haves

At least 1–2 years of experience with MassHealth eligibility and the application process.
Bilingual Spanish/English.

Responsibilities

Analyze prospect eligibility for Medicaid and Medicare enrollment.
Stay up to date on Medicaid and Medicare requirements.
Work with existing SCO and One Care prospects who have expressed interest in enrolling with Mass General Brigham Health Plan.
Deliver an exceptional prospect experience through telephone and written outreach.
Explain eligibility requirements and applicable forms and assist prospects through the Medicaid and Medicare processes.
Collaborate with Duals Field and Inside Sales Representatives, external brokers, and other stakeholders on pipeline cases.
Identify operational inefficiencies and process bottlenecks and recommend workflow and enrollment-experience improvements.
Support the creation and maintenance of health plan policies, procedures, and workflows to meet regulatory requirements.
Monitor and document member outreach in the CRM system.