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Medicaid Eligibility Specialist – Medicaid Application Experience
Fallon HealthMedicaid Eligibility Specialist ensuring accurate enrollment and eligibility data for Fallon Health's Medicaid programs. Collaborates with teams to provide timely and accurate information while handling customer inquiries.
Posted 6/26/2026full-timeWorcester • Massachusetts • 🇺🇸 United StatesMid-LevelSenior💰 $26 per hourWebsite
About the role
Key responsibilities & impact- Maintains active and consistent availability on the phone system, as scheduled, for all lines of business both Commercial and Regulatory.
- Meets internal/external deadlines and remains in compliance with CMS and EOHHS regulations
- Prioritizes daily and weekly work
- Responsible for maintaining professional relationships with customers/vendors; including resolving identified discrepancies in a timely manner
- Works proactively to ensure the enrollment and billing records are kept current and accurate. Ensures goals and turnaround standards are being met or exceeded based on corporate and departmental metrics.
- Responsible for maintaining up to date primary care physician assignments in core system accurately and timely. This is to be completed through review of data integrity reports, and working closely with Customer Service, Provider Relations, Contracting and ---- Account and Provider Configuration.
- Maintains professional etiquette and positively represents Fallon Health when meeting in-person with customers for eligibility and premium related inquiries.
- Assists with core system upgrade testing
- Completes other tasks assigned.
- Creating/maintaining desk top procedures and P&P’s
- Participates in departmental and company-wide process improvement projects, training, upgrade testing and team meetings as assigned.
- Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.
- Works department returned mail
- Responsible for maintaining up to date productivity records on a daily and monthly basis for corporate and departmental dashboards.
Requirements
What you’ll need- High School diploma required; bachelor’s degree preferred
- 4 plus years’ experience in an office environment, preferably in health care and/or managed care system
- Strong analytical and problem-solving skills
- Aptitude towards mathematical fundamentals
- Flexibility in a fast-paced environment.
- Excellent Organizational skills/time management
- Strong focus on quality & performance results
- Systems knowledge including but not limited to MS Excel, MS Word, MS Access.
- Ability to effectively communicate, both written and verbal.
- Builds Relationships/contributes to team performance
- Adhere to all DOI, State, and Federal guidelines
- Knowledge of Medicare and Medicaid eligibility requirements highly desirable.
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Fallon Health Website LinkedIn All Job Openings 1001 - 5000 employees Founded 1977 ⚕️ Healthcare Insurance 💸 Finance 👥 B2C Healthcare Insurance
- Finance
- B2C Fallon Health is a health insurance provider that simplifies health coverage for individuals, families, and Medicare recipients. They offer a variety of health plans including Medicare and MassHealth, along with resources for members such as fitness reimbursement programs and member portals to track deductibles and manage claims. Fallon Health focuses on providing accessible healthcare options and support for caregivers, ensuring comprehensive care for their members. Medicaid Eligibility Specialist – Medicaid Application Experience 🔥 6 minutes ago 🏢🏡 Worcester – Hybrid 💵 $26 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Maintains active and consistent availability on the phone system, as scheduled, for all lines of business both Commercial and Regulatory.
- Meets internal/external deadlines and remains in compliance with CMS and EOHHS regulations
- Prioritizes daily and weekly work
- Responsible for maintaining professional relationships with customers/vendors; including resolving identified discrepancies in a timely manner
- Works proactively to ensure the enrollment and billing records are kept current and accurate. Ensures goals and turnaround standards are being met or exceeded based on corporate and departmental metrics.
- Responsible for maintaining up to date primary care physician assignments in core system accurately and timely. This is to be completed through review of data integrity reports, and working closely with Customer Service, Provider Relations, Contracting and ---- Account and Provider Configuration.
- Maintains professional etiquette and positively represents Fallon Health when meeting in-person with customers for eligibility and premium related inquiries.
- Assists with core system upgrade testing
- Completes other tasks assigned.
- Creating/maintaining desk top procedures and P&P’s
- Participates in departmental and company-wide process improvement projects, training, upgrade testing and team meetings as assigned.
- Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.
- Works department returned mail
- Responsible for maintaining up to date productivity records on a daily and monthly basis for corporate and departmental dashboards. 🎯 Requirements
- High School diploma required; bachelor’s degree preferred
- 4 plus years’ experience in an office environment, preferably in health care and/or managed care system
- Strong analytical and problem-solving skills
- Aptitude towards mathematical fundamentals
- Flexibility in a fast-paced environment.
- Excellent Organizational skills/time management
- Strong focus on quality & performance results
- Systems knowledge including but not limited to MS Excel, MS Word, MS Access.
- Ability to effectively communicate, both written and verbal.
- Builds Relationships/contributes to team performance
- Adhere to all DOI, State, and Federal guidelines
- Knowledge of Medicare and Medicaid eligibility requirements highly desirable. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Per Diem ED Radiologist – Remote Reads 🕒 May 26 UMass Memorial Health 10,000+ employees ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Seeking Per Diem ED Radiologist offering onsite or remote reading options. Join UMass Memorial Medical Group's team covering multiple hospitals with advanced imaging technologies. 🏢🏡 Worcester – Hybrid 💵 $175 - $209 / hour 💰 $4.7M Grant on 2022-12 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs
ATS Keywords
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Hard Skills & Tools
data integrityenrollmentbillingcore system upgrade testingproductivity recordsanalytical skillsproblem-solvingmathematical fundamentalstime managementquality performance
Soft Skills
flexibilityorganizational skillscommunicationrelationship buildingteam performanceprofessional etiquetteproactive workcustomer servicediscrepancy resolutionprocess improvement
Certifications
High School diplomaBachelor’s degree (preferred)