Benefits and Eligibility Specialist
Company: State of Massachusetts
Posted on: September 22, 2022
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
* 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
* Input applicant data into agency's 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
* 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 customer's 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
* 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.
* Active, empathetic listener with strong writing and verbal
* 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
* Proficient usage of Microsoft Office products including Outlook,
Word, and Excel.
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.
For more information about our agency and programs please visit:
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.
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 Division's Hiring
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.
If you require assistance with the application/interview process
and would like to request an ADA accommodation, please click on the
link and complete the Reasonable Accommodation Online Request
For questions, please the contact the Office of Human Resources at
1-800-510-4122 and select option #2.
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
* 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.
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
Want the specifics? Explore our Employee Benefits and Rewards!
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
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.
Keywords: State of Massachusetts, Taunton , Benefits and Eligibility Specialist, Other , Taunton, Massachusetts
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