DSNP MassHealth Eligibility Representative

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The position is primarily assisting folks who need MassHealth, assisting them to apply for the first time, renew, or apply for waivers. The ideal candidate has MassHealth application experience and knowledge. Responsible for outreaching to Dual Eligible prospects to assist them with the Medicaid Enrollment process from start to finish, as well as provide Medicare Enrollment guidance. This position is responsible for monitoring and optimizing processes related to MassHealth & Medicare eligibility and enrollment. Will work with existing Dual prospect referrals from the DSNP Sales Reps and external brokers, and conversions will go toward an individual, monthly target.

Essential Functions

• Analyze prospect eligibility related to the Medicaid & Medicare enrollment process.
• Keep up to date on Medicaid and Medicare requirements.
• The role will work with existing SCO & One Care prospects who have identified a desire to enroll with MGBHP.
• Deliver an exceptional prospect experience via both telephonic and written outreach.
• Assist prospects with the Medicaid & Medicare process by explaining eligibility requirements and applicable forms.
• Collaborate with internal team, specifically Duals Field and Inside Sales Reps, and external brokers to work on pipeline cases.
• Collaborate with external stakeholders if needed.
• Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve enrollment experience.
• Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with regulatory requirements (e.g., CMS, Medicaid, Medicare, state and federal laws).
• Monitor and document member outreaches in the CRM system.

Qualifications

Education High School Diploma or Equivalent required

Experience At least 2-3 years of experience in sales, healthcare, or insurance with a focus on Government Markets required

Experience At least 1-2 years of experience with MassHealth Eligibility and Application Process preferred

Bilingual (Spanish/English) preferred

Knowledge, Skills, and Abilities Familiarity with relevant healthcare regulations, including the Health Insurance Portability and Accountability Act, to ensure compliance and maintain patient confidentiality. Familiarity with call center software, customer relationship management systems, and other relevant tools used in a call center environment. Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment. Familiarity with the healthcare industry, hospital operations, and medical terminology is important for effectively understanding and addressing customer inquiries. Familiarity with Dual Eligible products in Massachusetts. Ability to motivate and inspire staff to provide exceptional customer service while maintaining productivity and efficiency. Strong problem-solving skills to handle escalated or challenging customer interactions effectively. Dedication to providing exceptional customer service and ensuring a positive experience for patients, visitors, and other stakeholders. Ability to travel to meet with internal and external partners and prospects.

Working Conditions

Hybrid role with a combination of remote work, local travel, and quarterly in-person team meetings in Somerville, MA

Periodic local travel required to visit customer/client accounts.

Candidates must be able to travel locally with reliable transportation

Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees

This is a full-time role with a Monday through Friday schedule, generally 8:30-5:00 PM Eastern Time

Work Details

Remote Type Hybrid Work Location 399 Revolution Drive

Scheduled Weekly Hours 40

Employee Type Regular Work Shift Day (United States of America)

Pay Range $25.50 - $36.49/Hourly Grade 5

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at View phone number on click.appcast.io.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Are you ready?

Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.

Combat disease. Hold a hand. Help people. Impact the world. Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives.