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DSNP MassHealth Eligibility Representative

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Mar 21, 2026
Responsible for outreaching to Dual Eligible prospects to assist them with the Medicaid Enrollment process from start to finish, as well as provide Medicare Enrollment guidance. This position is responsible for monitoring and optimizing processes related to MassHealth & Medicare eligibility and enrollment. Will work with existing Dual prospect referrals from the DSNP Sales Reps and external brokers, and conversions will go toward an individual, monthly target. Essential Functions -Analyze prospect eligibility related to the Medicaid & Medicare enrollment process. -Keep up to date on Medicaid and Medicare requirements. -The role will work with existing SCO & One Care prospects who have identified a desire to enroll with MGBHP. -Deliver an exceptional prospect experience via both telephonic and written outreach. -Assist prospects with the Medicaid & Medicare process by explaining eligibility requirements and applicable forms. -Collaborate with internal team, specifically Duals Field and Inside Sales Reps, and external brokers to work on pipeline cases. -Collaborate with external stakeholders if needed. -Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows and improve enrollment experience. -Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with regulatory requirements (e.g., CMS, Medicaid, Medicare, state and federal laws). -Monitor and document member outreaches in the CRM system. Education High School Diploma or equivalent required Experience At least 2-3 years of experience in sales, healthcare, or insurance with a focus on Government Markets required At least 1-2 years of experience with MassHealth Eligibility and Application Process preferred Knowledge, Skills, and Abilities Familiarity with relevant healthcare regulations, including the Health Insurance Portability and Accountability Act, to ensure compliance and maintain patient confidentiality. Familiarity with call center software, customer relationship management systems, and other relevant tools used in a call center environment. Familiar with related CMS and State regulatory guidelines related to Medicare Advantage and DSNP enrollment. Familiarity with the healthcare industry, hospital operations, and medical terminology is important for effectively understanding and addressing customer inquiries. Familiarity with Dual Eligible products in Massachusetts. Ability to motivate and inspire staff to provide exceptional customer service while maintaining productivity and efficiency. Strong problem-solving skills to handle escalated or challenging customer interactions effectively. Dedication to providing exceptional customer service and ensuring a positive experience for patients, visitors, and other stakeholders. Ability to travel to meet with internal and external partners and prospects. Working Conditions This is a hybrid role that will include travel to providers' offices Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.