Benefits and Eligibility Specialist

MASSHEALTH Operations (MHO) is seeking an experiences customer service professional for the role of Benefits and Eligibility Specialist. The selected candidate will work for the 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.

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

• Determines initial eligibility for populations covered by traditional MassHealth laws and policies – principally elders and individuals receiving Long Term Care by applying program criteria and analyzing financial and medical documentation including household composition data, taxes, trusts, income level, properties, assets, liabilities, annuities, securities, insurance information and medical records.
• Facilitates the accurate and timely determination of initial eligibility by explaining requirements and following up with customers who do not submit required verifications.
• Communicates with customer(s) and/or their authorized representatives to explain programmatic requirements including but not limited to: transfer of asset rules, estate and property guidelines, evaluation of income and assets from trusts, retention of spousal income and assets, etc., and alternative methods to validate reported information, to request information needed to establish eligibility and to inform applicants of the need to complete supplemental forms to appropriate unit.
• Appraise the value, ownership, relationship and accessibility of assets and income to determine the conditions of eligibility based on program rules, such as liens, penalty and disqualification periods. 
• Perform calculations to determine income allowance and ability to retain excess assets in spousal situations.
• Determine eligibility status – approved, denied or pending, based on standard criteria, within prescribed timeframes, by identifying assets, performing income and asset calculations, and approving deductions.
• Input applicant data into agency’s computer system to establish and update customer data, validate data and make corrections on agency computer system.
• Validates customer demographic, financial and background data by contacting applicant to obtain information not listed on eligibility forms, contacting collateral sources and determining immigrant status by reviewing immigrant documentation.
• Responds to customer inquiries and provides information regarding eligibility requirements, process appeal rights and procedures to customers, applicants, attorneys, estate planners, advocates, public officials, external agencies, the public or other parties by explaining applicable rules, regulations, policies, procedures, and eligibility requirements to ensure that all parties understand the availability and eligibility for benefits by researching case status on agency computer systems.
• Represents agency at hearings by preparing and delivering explanations of eligibility determinations.
• Provides requested services and makes appropriate referrals for customers to external programs for which they may qualify.
• Determine initial eligibility by analyzing categorical information, financial documentation and clinical assessments and applying special eligibility rules as needed based on the criteria of the case.
• Complete and send notices as appropriate based on eligibility determination.
• Determine wh