Health Benefit Rep

Job description

Position Purpose: The Health Benefit Representative (HBR) is responsible for educating and assisting individuals with enrolling in affordable health insurance coverage through the NY State of Health Marketplace. This includes Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plans (QHP), and Health & Recovery Plan (HARP). The HBR engages prospective members who are uninsured or seeking new coverage and supports existing members with renewals and benefit education. All activities are performed in compliance with the Affordable Care Act (ACA), FE Integrity Guidelines, Regulatory Guidelines, and Fidelis Care Standards, with a strong focus on customer experience and community engagement. Key Details: Community field based travel position covering Queens County, NY. Educate prospects and members on New York State of Health coverage options, support new enrollments and renewals, and prioritize enrollment growth through trust and accountability. Educate and assist individuals with enrolling in coverage through the NY State of Health Marketplace, including Medicaid (NYM), Child Health Plus (CHP), Essential Plan (EP), Qualified Health Plans (QHP), and Health & Recovery Plan (HARP). Explain eligibility for public programs, federal premium tax credits, and cost-sharing reductions, including potential impacts to consumers. Teach members about Fidelis digital tools (member portal, mobile app) Describe plan features, benefits, and cost-sharing mechanisms (deductibles, co-pays, co-insurance) and how these affect consumers. Explain metal tiers within the Marketplace and how benefits vary by income level. Assist consumers with submitting required documents via scan, fax, or mail. Support existing members with renewals and recertifications. Help consumers with premium payment submissions when required. Provide culturally and linguistically appropriate assistance. Conduct public education activities and presentations to raise awareness of Fidelis Care products and Marketplace options. Participate in ACA forums, workshops, and community events as requested. Maintain a daily tracking tool that entails detailed rep activity. Monitor all applications in personal dashboard to ensure timely and accurate follow through from applicants. Conduct a daily review of personal dashboard to address and follow-up on any and/or all potential leads for consumers seeking assistance. Keep abreast of all the Marketplace functionalities to effectively manage individual accounts. Follow-up on all new potential enrollment leads and consumer inquiries. Record all follow-up dispositions in a timely and accurate manner within the required "CRM". Data enter all applicant demographic, enrollment site and PCP selection data in the required "CRM" at the time of the initial enrollment encounter. Must be in compliance with all conflict-of-interest standards and regulations. Required to work evenings and weekends. Secure and safeguarding confidential information to prevent Protected Health Information (PHI) from being obtained from unauthorized personnel to ensure compliance with privacy and security standards. Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Marketplace. Participate in all trainings, updates and webinars and other forums in which information is necessary to carry out roles and responsibilities. Mandated to meet the annual Marketplace Facilitated Enroller (MFE) recertification requirements. Keep abreast of all industry and regulatory updates as it pertains to the ACA and Marketplace. Maintain discretion regarding business-related files, reports, and conversations within the provisions of applicable State and Federal Statutes and regulations. Perform all other tasks and responsibilities as required to satisfy the expectations of the role. Performs other duties as assigned. Complies with all policies and standards. Additional Experience/Skills Bilingual – English/Spanish Highly Preferred and all other second languages Community Outreach Front Facing Field Sales CAC Certification preferred MS Office Suite Salesforce Public Work Schedule: Mon. - Fri. with occasional evenings and weekends Education/Experience: Must have a High School Diploma or GED 2+ years of prior experience in managed care, sales, customer service or related experience preferred Must have basic computer skills Driver's License: Preferred for NYC counties, Mandatory for non-NYC counties Certifications: Must complete and pass the NY State of Health approved training program and become certified. Must complete all required annual recertification courses/learnings. Pay Range: $23.23 - $39.61 per hour At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act