DSNP MassHealth Eligibility Representative
About The Position
The DSNP MassHealth Eligibility Representative assists people seeking MassHealth with initial applications, renewals, and waiver applications. The role outreaches to Dual Eligible prospects and guides them through Medicaid enrollment from start to finish, while also providing Medicare enrollment guidance. The representative monitors and optimizes MassHealth and Medicare eligibility and enrollment processes, working with referrals from DSNP Sales Representatives and external brokers. Conversions contribute to an individual monthly target. This hybrid position combines remote work, local travel, and quarterly in-person team meetings in Somerville, Massachusetts. The schedule is Monday through Friday, generally 8:30 a.m. to 5:00 p.m. Eastern Time, for 40 hours per week. Remote work requires a stable, secure, quiet, HIPAA-compliant workspace. Local travel to customer or client accounts is periodically required, and reliable transportation is necessary.
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, CRM systems, and other tools used in a call center environment.
- 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 handling escalated or challenging customer interactions.
- Dedication to exceptional customer service and a positive experience for patients, visitors, and other stakeholders.
- Ability to travel to meet with internal and external partners and prospects; reliable local transportation is required.
- Ability to work remotely in a stable, secure, quiet, and HIPAA-compliant workspace.
Nice To Haves
- At least 1–2 years of experience with the MassHealth eligibility and application process.
- Bilingual Spanish and English.
Responsibilities
- Analyze prospect eligibility related to Medicaid and Medicare enrollment.
- Keep up to date on Medicaid and Medicare requirements.
- Work with existing SCO and One Care prospects who have indicated interest in enrolling with MGBHP.
- Deliver an exceptional prospect experience through telephone and written outreach.
- Explain eligibility requirements and applicable forms, and assist prospects with the Medicaid and Medicare processes.
- Collaborate with Duals Field and Inside Sales Representatives and external brokers on pipeline cases.
- Collaborate with external stakeholders as needed.
- 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 ensure compliance with CMS, Medicaid, Medicare, and state and federal laws.
- Monitor and document member outreach in the CRM system.
- Meet with internal and external partners and prospects through required local travel.
Benefits
- Competitive salaries and a benefits package.
- Flexible work options.
- Career growth and advancement opportunities.
- Differentials, premiums, and bonuses as applicable.
- Recognition programs.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Education Level
High school or GED
