State of Massachusetts Benefits and Eligibility Representative in Quincy, Massachusetts

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.

___General Statement of Duties and Responsibilities:_

Evaluate and assist individuals with request for hearings in identifying issue for hearing; determine if a hearing is necessary; determine eligibility status with expertise in data available through the Virtual Gateway, MyWorkSpace, MA-21, PACES, NewMMIS, Optum & hCentive; Prepare and deliver explanations of eligibility determinations to assist in defining issue for hearing; and serve as eligibility specialists to manage all eligibility hearing issues on intake through resolution informally (not timely, did not attend process and other resolution and resolution via informal resolution process).

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

  • Evaluate and reviews applicable forms requesting a hearing and submitted documents, to insure accuracy and completeness of information and forward eligibility supplemental form(s) and/or verification(s) to appropriate MassHealth unit(s) and or assigned MassHealth Enrollment Center (MEC).

  • Access information on Authorized Representative to determine if authority exists for individuals filing on behalf of applicant/member/appellant update and validate information and makes necessary corrections in the current Board of Hearings (BoH) Appeals Processing System, (APS) or (.Net).

  • Access NewMMIS to assist in researching eligibility status.

  • Accesses eligibility notices for appeals filed and determines if appeal is timely filed, filed by correct individual and establish aid pending in the correct benefit.

  • Ensure appellants are notified of a timely appeal and aid pending status.

  • Manage hearing disposition on appeals not timely appealed.

  • Manage hearing disposition on hearings the appellant fails to attend including removing aid pending protection when appropriate.

  • Manage disposition of appeals resolved (B99 process) and appeals dismissed outside of hearing, with written notice if appropriate.

  • Responsible for assigned phone responsibilities to responds to applicant/member/appellant/respondent (agency) inquiries and provides information regarding eligibility requirements related to appeal.

  • Perform quality customer service by responding to all applicant/member/appellant/respondent inquiries in a professional, efficient and courteous manner related to requests for hearings, requests for telephonic hearings, requests to withdraw a hearing and requests to reschedule a hearing.

  • Responds to requests for hearing forms and hearing information in an expedient and efficient manner.

  • Explains appeal rights and procedures to applicants, members, appellants, respondents, attorneys, advocates, providers, public officials, external agencies, the public or other parties.

  • Explains applicable rules, regulations, policies, procedures and eligibility requirements to ensure that all parties understand how to access a determination on eligibility for benefits.

  • Performs related work as required such as contacting applicants by phone, maintaining and updating policy and procedures manuals, data entry, filing, reporting, attending staff meetings and attending training sessions and completing special projects in accordance with agency directives.

_Preferred Qualifications_:

  • Knowledge of the laws, rules, regulations, policies, procedures, specifications, standards and guidelines governing agency operations and assigned appeals unit activities.

  • Knowledge of the types and uses of agency forms and assigned appeals unit forms.

  • Knowledge of referral sources available for providing services to applicants/members/appellants and respondents.

  • Knowledge of interviewing techniques.

  • Knowledge of agency computer and information systems (PACES, MA-21, Optum HIX, Virtual Gateway, NewMMIS).**

_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.

This requisition will remain open until filled; however, 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.

Job: *Community and Social Services

Organization: *Exec Office Of Health and Human Services

Title: Benefits and Eligibility Representative

Location: Massachusetts-Quincy - 100 Hancock Street

Requisition ID: 1700027Q