Eligibility Representative

🔥 0 minutes ago

🐊 Florida, Massachusetts – Remote

🐊 Florida – Remote 🍂 Massachusetts – Remote

💵 $27 - $41 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Point32Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Point32Health is a leading nonprofit health and well-being organization that provides health coverage and services for individuals at all life stages. Through its family of companies, including Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health offers a variety of health plans, programs, and services encompassing medical, pharmacy, wellness, and behavioral health. Point32Health is committed to health equity and has been recognized for its inclusive practices, earning distinctions in areas such as health equity, disability inclusion, and LGBTQ+ workplace inclusion. With a focus on innovative solutions and high-quality coverage, Point32Health strives to create a better healthcare experience for its members and communities.

📋 Description

• Serve as a MassHealth subject matter expert and stay current on eligibility policies and regulations • Review new policy updates and communicate changes to the team • Support seniors and members who may qualify for MassHealth, Medicare, Home and Community-Based Waiver, SCO, or One Care programs • Conduct outreach to community organizations and provider groups • Deliver presentations on program guidelines, eligibility, and enrollment • Facilitate SCO referrals • Organize and participate in community events • Generate SCO leads to support membership growth • Communicate with prospects, members, and caregivers by phone or in person • Explain eligibility criteria and assess eligibility • Assist Medicaid-only prospects and members in obtaining Medicare • Support MassHealth redetermination efforts and serve as liaison among enrollment, clinical, external ASAP, and care management teams • Complete applications and renewal forms with prospects, members, and caregivers • Troubleshoot application issues and collect required documentation • Track application status through MMIS or the MassHealth Enrollment Center • Notify applicants of approvals and connect them with SCO enrollment experts • Develop outreach plans within the assigned territory • Provide weekly activity plans and result summaries • Document activities and interactions in the CRM platform • Provide professional, efficient, and courteous customer service • Handle complaints and escalate issues when necessary • Participate in team meetings and continuous improvement initiatives • Perform other assigned duties and projects

🎯 Requirements

• High school diploma required • Active Health Producer license for the state of Massachusetts is a plus • 1-3 years of professional experience • Experience conducting community outreach and public presentations • Strong knowledge of Medicaid and Medicare programs, including eligibility requirements and enrollment policies • Experience providing enrollment assistance • Ability to work with diverse populations, including the elderly and their caregivers • Excellent written, oral, and interpersonal communication skills • Strong presentation skills and ability to convey complex information clearly • Outstanding customer service skills with a consultative approach • Excellent time management, organizational skills, and attention to detail • Planning, problem-solving, and analytical skills • Ability to work independently and collaborate with internal staff and external partners • Proficiency in MS Office, Word, PowerPoint, and Excel • Bilingual or multi-lingual required • Must be able to work under normal office conditions and work from home as required • Must be able to work additional hours beyond the standard work schedule when required • Must complete annual product training, AHIP certification, and additional required training or certification • Must maintain compliance with required certifications, licensing, continuing education, policy acknowledgment, and work plan documents

🏖️ Benefits

• Medical, dental and vision coverage • Retirement plans • Paid time off • Employer-paid life and disability insurance with additional buy-up coverage options • Tuition program • Well-being benefits • Full suite of benefits to support career development, individual & family health, and financial health • Variable pay eligibility