Benefits and Eligibility Specialist

Commonwealth of Massachusetts - Tewksbury, MA3.9

Full-time$57,000 - $78,000 a year
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 currently seeking experienced customer service professionals for our 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.

MassHealth, the Commonwealth’s Medicaid program, provides health care benefits to certain low and medium-income Massachusetts residents. As an innovative national leader, the Commonwealth’s Medicaid program offers the opportunity to work with state-of-the-art technologies in a cutting-edge, fast-paced, call center environment. Selected applicants will have exceptional customer service, communications, and analytical skills. We offer a unique opportunity to serve, and to make a positive contribution to our members.

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

Review and evaluate applications to determine applicant eligibility for health insurance benefits

Assist applicants in gathering required documents to complete MassHealth applications

Communicate with applicants or other authorized representatives to explain programmatic requirements for all MassHealth programs

Research and validate demographic information including Massachusetts residency, background data, immigration status, and financial information

Compare information provided on MassHealth applications with data from other agencies to verify initial and continued eligibility for benefits

Explain appeal rights and procedures to applicants, attorneys, advocates, providers, public officials, and the general public

Prepare and present explanations of eligibility determinations and represent MassHealth at appeals hearings

Provide subject matter expertise as an internal resource by assisting lower level staff in interpreting policy, understanding and processing more complex/difficult eligibility cases

Compile service-related statistics and special projects; prepare statistical and narrative reports to track and evaluate office performance

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

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.

Total Compensation:
As an employee of the Commonwealth of Massachusetts, you are offered a great career opportunity influencing a wide-spectrum of services to the diverse populations we serve - but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits which you should consider towards your overall compensation, including:

  • 75% state paid medical insurance premium
  • Reasonable Dental and Vision Plans
  • Flexible Spending Account and Dependent Care Assistance programs
  • Low cost basic and optional life insurance
  • Retirement Savings: State Employees' Pension and a Deferred Compensation 457(b) plan
  • 11 paid holidays per year and competitive Sick, Vacation and Personal Time
  • Tuition Benefit for employee and spouse at state colleges and universities
  • Short-Term Disability and Extended Illness program participation options
  • Incentive-based Wellness Programs
  • Professional Development and Continuing Education opportunities
  • Qualified Employer for Public Service Student Loan Forgiveness Program
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 the 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.

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.

  • 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.

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

Official Title: Benef Elig & Refer Soc Wrk (C)
Primary Location: United States-Massachusetts-Tewksbury-367 East Street
Job: Community and Social Services
Agency: Exec Office Of Health and Human Services
Schedule: Full-time
Shift: Day
Job Posting: Mar 26, 2019, 1:21:32 PM
Number of Openings: 1
Salary: 57,198.44 - 77,710.62 Yearly
If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator: Chantal St. Fleur - 617-348-8471
Bargaining Unit: 08-SEIU - Local 509 - Social/Rehabilitation
Confidential: No