Benefits and Eligibility Representative

Commonwealth of Massachusetts - Springfield, MA3.9

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.

MassHealth Operations (MHO) is seeking dynamic customer service professionals for the role of Benefits and Eligibility Representative. Applicants 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):

Respond to applicants under the age of 65 living in the community requesting benefits and assist in the completion of eligibility form.
Process and review required verifications in order to obtain and validate demographic information including Massachusetts residency, background data, immigration status, and financial information.
Evaluate and examine enrollment/eligibility submissions to identify any missing data and to certify information provided; reconcile any discrepancies.
Inform and respond to applicants regarding enrollment-related policies and procedures; review eligibility guidelines and enrollment criteria to ensure their understanding.
Reconcile MHO case information with data from other agencies and sources to verify continued eligibility for benefits.
Explain appeal rights, eligibility rules, and procedures to applicants, attorneys, advocates, providers, public officials, external agencies, general public and other third parties.
Represent the 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;

Special Requirements:
Based on assignment, possession of a current and valid Massachusetts Class D Motor Vehicle Operator’s license or the equivalent from another state may be required.

Pre-Hire 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

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 contact the CYF 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: 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.

  • 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.

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