Benefits and Eligibility Representative

Company: State of Massachusetts
Location: Quincy
Posted on: September 15, 2022

Job Description:

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 MassHealth 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 insure accuracy and completeness and to support the initial and continued determination of eligibility for programs administered by MassHealth 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

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 verbal /written 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 MASSHEALTH:

MassHealth, the Commonwealth's Medicaid program, provides health care benefits to certain low and medium-income Massachusetts residents. As an innovative national leader, the Commonwealth's Medicaid program offers the opportunity to work with state-of-the-art technologies in a cutting-edge, fast-paced, call center environment. Selected applicants will have exceptional customer service, communications, and analytical skills. We offer a unique opportunity to serve, and to make a positive contribution to our members.

The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Total Compensation:

As an employee of the Commonwealth of Massachusetts you are offered a great career opportunity influencing a wide-spectrum of services to the diverse populations we serve - but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits which you should consider towards your overall compensation, including:

* 75% state paid medical insurance premium
* Reasonable Dental and Vision Plans
* Flexible Spending Account and Dependent Care Assistance programs
* Low cost basic and optional life insurance
* Retirement Savings: State Employees' Pension and a Deferred Compensation 457(b) plan
* 12 paid holidays per year and competitive Sick, Vacation and Personal Time
* Tuition Benefit for employee and spouse at state colleges and universities
* Short-Term Disability and Extended Illness program participation options
* Incentive-based Wellness Programs
* Professional Development and Continuing Education opportunities
* Qualified Employer for Public Service Student Loan Forgiveness Program

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2.

MINIMUM ENTRANCE 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.

SUBSTITUTIONS:

* A Bachelor's or higher degree may be substituted for the required experience on the basis of two years of education for one year of experience.
* One year of education equals 30 semester hours. Education toward a degree will be prorated on the basis of the proportion of the requirements actually completed.

LICENSES: Based on assignment, travel may be required. Those employees who elect to use a motor vehicle for travel must have a current and valid Massachusetts Class D Motor Vehicle Operator's license or the equivalent from another state.

Executive Order #595: As a condition of employment, successful applicants will be required to have received COVID-19 vaccination or an approved exemption as of their start date. Details relating to demonstrating compliance with this requirement will be provided to applicants selected for employment. Applicants who receive an offer of employment who can provide documentation that the vaccine is medically contraindicated or who object to vaccination due to a sincerely held religious belief may make a request for exemption.

An Equal Opportunity/Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

Keywords: State of Massachusetts, Quincy , Benefits and Eligibility Representative, Other , Quincy, Massachusetts