Benefits and Eligibility Specialist
: Job Details :

An Official website of the Commonwealth of Massachusetts

Job Description - Benefits and Eligibility Specialist (2500060H)

Job Description

Benefits and Eligibility Specialist - ( 2500060H )

Description

MASSHEALTH Operations (MHO) is seeking an experiences customer service professional for the role of Benefits and Eligibility Specialist. The selected candidate will work for the Intake Unit to determine applicant eligibility for health care benefits for the over 65 population.As an expert internal resource, you will determine applicant eligibility, help interpret policy, and handle the more complex and difficult eligibility determination cases. Incumbents of these positions will also be assigned non-supervisory duties including performing any of the duties of the Benefits and Eligibility Representative role.

Duties and Responsibilities (these duties are a general summary and not all inclusive) :

• Determines initial eligibility for populations covered by traditional MassHealth laws and policies principally elders and individuals receiving Long Term Care by applying program criteria and analyzing financial and medical documentation including household composition data, taxes, trusts, income level, properties, assets, liabilities, annuities, securities, insurance information and medical records.
• Facilitates the accurate and timely determination of initial eligibility by explaining requirements and following up with customers who do not submit required verifications.
• Communicates with customer(s) and/or their authorized representatives to explain programmatic requirements including but not limited to: transfer of asset rules, estate and property guidelines, evaluation of income and assets from trusts, retention of spousal income and assets, etc., and alternative methods to validate reported information, to request information needed to establish eligibility and to inform applicants of the need to complete supplemental forms to appropriate unit.
• Appraise the value, ownership, relationship and accessibility of assets and income to determine the conditions of eligibility based on program rules, such as liens, penalty and disqualification periods.
• Perform calculations to determine income allowance and ability to retain excess assets in spousal situations.
• Determine eligibility status approved, denied or pending, based on standard criteria, within prescribed timeframes, by identifying assets, performing income and asset calculations, and approving deductions.
• Input applicant data into agencys computer system to establish and update customer data, validate data and make corrections on agency computer system.
• Validates customer demographic, financial and background data by contacting applicant to obtain information not listed on eligibility forms, contacting collateral sources and determining immigrant status by reviewing immigrant documentation.
• Responds to customer inquiries and provides information regarding eligibility requirements, process appeal rights and procedures to customers, applicants, attorneys, estate planners, advocates, public officials, external agencies, the public or other parties by explaining applicable rules, regulations, policies, procedures, and eligibility requirements to ensure that all parties understand the availability and eligibility for benefits by researching case status on agency computer systems.
• Represents agency at hearings by preparing and delivering explanations of eligibility determinations.
• Provides requested services and makes appropriate referrals for customers to external programs for which they may qualify.
• Determine initial eligibility by analyzing categorical information, financial documentation and clinical assessments and applying special eligibility rules as needed based on the criteria of the case.
• Complete and send notices as appropriate based on eligibility determination.
• Determine whether income and/or asset deductions are met by evaluating medical bills and updating information on the computer system as required.
• Provides quality customer service by responding to all customer inquiries in a professional, efficient and courteous manner.
• Responds to customers requests for applications and information in an expedient and efficient manner.
• Provides assistance to agency staff as required.
• Completes workaround projects in accordance with agency directives.
• Performs related work as required such as: contacting applicants by phone, maintaining and updating policy and procedures manuals, attending staff meetings and training sessions and completing workaround projects in accordance with agency directives.

Required Qualifications:

• Ability to follow a given rule or set of rules correctly in order to arrange things or actions in a certain order.
• Ability to listen to and understanding information and ideas presented either through spoken words and sentences or through a reasonable accommodation.
• Ability to communicate information and ideas so others will understand, either in speaking or through a reasonable accommodation.
• Ability to read and understanding information and ideas presented in writing.
• Ability to communicate information and ideas in writing so others will understand.
• Ability to apply general rules to specific problems to come up with logical answers.
• Ability to combine separate pieces of information, or specific answers to problems, to form general rules or conclusions.

Preferred Qualifications :

• Active, empathetic listener with strong writing and verbal communications skills.
• Genuine service-orientated individual with a commitment to effective customer service and concern for others needs.
• Keen attention to detail; the ability to research and analyze complex financial, tax and insurance documents; capacity to assess the value of assets and income.
• Sound judgment with an aptitude to keep composed in difficult situations.
• 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:

To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainable & equitable health, well-being, independence, and quality of life.

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

Education, licensure and certifications will be verified in accordance with the Human Resources Divisions 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 Commonwealths website.

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

Qualifications

First consideration will be given to those applicants that apply within the first 14 days. MINIMUM ENTRANCE REQUIREMENTS: REQUIRED WORK EXPERIENCE: At least four years of full-time, or equivalent part-time, professional 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 two years of 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 Motor Vehicle Operator's license or the equivalent from another state.

Salary placement is determined by a combination of factors, including the candidates years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Divisions Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

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

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC)may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Official Title : Benef Elig & Refer Soc Wrk (C)

Primary Location Primary Location : United States-Massachusetts-Tewksbury-367 East Street Job Job : Community and Social Services Agency Agency : Exec Office Of Health and Human Services Schedule Schedule : Full-time Shift Shift : Day Job Posting Job Posting : Aug 18, 2025, 10:36:39 AM Number of Openings Number of Openings : 3 Salary : 70,698.94 - 96,052.32 Yearly

If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator : Kendy Derival/...@mass.gov - 617#######

Bargaining Unit : 08-SEIU - Local 509 - Social/Rehabilitation

Confidential : No

Potentially Eligible for a Hybrid Work Schedule : Yes

#J-18808-Ljbffr