Eligibility Representative

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Act as a subject matter expert on MassHealth and keep updated on eligibility policies and regulations.

• Evaluate new policy updates and relay changes to the team.

• Assist seniors and members who may be eligible for MassHealth, Medicare, Home and Community-Based Waiver, SCO, or One Care programs.

• Conduct outreach to community organizations and provider groups.

• Present program guidelines, eligibility criteria, and enrollment processes.

• Facilitate referrals for the SCO program.

• Organize and engage in community events.

• Generate leads for SCO to promote membership growth.

• Communicate with prospects, members, and caregivers via phone or in-person interactions.

• Clarify eligibility criteria and evaluate eligibility.

• Assist Medicaid-only prospects and members in securing Medicare.

• Support MassHealth redetermination efforts and act as a liaison among enrollment, clinical, external ASAP, and care management teams.

• Complete applications and renewal forms with prospects, members, and caregivers.

• Troubleshoot application issues and gather necessary documentation.

• Monitor application status through MMIS or the MassHealth Enrollment Center.

• Inform applicants of approvals and connect them with SCO enrollment specialists.

• Formulate outreach strategies within the designated territory.

• Provide weekly activity plans and summaries of results.

• Record activities and interactions in the CRM system.

• Deliver professional, efficient, and courteous customer service.

• Address complaints and escalate matters as needed.

• Attend team meetings and engage in continuous improvement initiatives.

• Execute other duties and projects as assigned.

⛳️ Requirements

• High school diploma is mandatory.

• An active Health Producer license for Massachusetts is advantageous.

• 1-3 years of relevant professional experience.

• Experience in community outreach and delivering public presentations.

• Comprehensive knowledge of Medicaid and Medicare programs, including eligibility criteria and enrollment policies.

• Background in providing enrollment assistance.

• Capacity to work with diverse populations, including the elderly and their caregivers.

• Excellent written, verbal, and interpersonal communication abilities.

• Strong presentation skills with the ability to communicate complex information clearly.

• Exceptional customer service skills with a consultative approach.

• Excellent time management and organizational skills, along with attention to detail.

• Strong planning, problem-solving, and analytical capabilities.

• Ability to work independently while collaborating with internal staff and external partners.

• Proficient in MS Office, including Word, PowerPoint, and Excel.

• Bilingual or multilingual proficiency is required.

• Must be able to work in typical office conditions and from home as necessary.

• Willingness to work additional hours beyond the standard schedule when required.

• Completion of annual product training, AHIP certification, and any additional required training or certification is necessary.

• Must maintain compliance with all required certifications, licensing, continuing education, policy acknowledgment, and work plan documents.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Retirement plans.

• Paid time off.

• Employer-paid life and disability insurance with additional buy-up options.

• Tuition assistance program.

• Well-being benefits.

• Comprehensive benefits package to support career development, individual and family health, and financial well-being.

• Eligibility for variable pay.