Enrollment Agent - PruittHealth Premier

PruittHealth•Raleigh, NC

10d•Hybrid

About The Position

The Enrollment Agent role for PruittHealth Premier serves as a licensed insurance agent responsible for explaining Plan benefits and answering questions from potential members or their responsible parties. The primary goal is to identify potential membership leads and ensure timely outreach to facilitate enrollment into the health plan. Additionally, the role involves providing ongoing marketing support to in-network skilled nursing facility staff, conducting facility and community marketing events, and offering provider education within skilled nursing facilities and communities to support both Institutional Special Needs Plans (I-SNP) and Dual Special Needs Plans (D-SNP) as needed.

Requirements

Strong technological skills to connect with potential members/families interested in enrolling.
Ability to maintain health insurance licensure and Continuing Education Requirements set forth by licensing state.
Comfortable/patient in communicating via web-based video platforms.
Assertive self-starter who is able to influence others.
Strong written and verbal communication skills with abilities to deliver presentations in an impactful manner.
Proven ability to work independently and productively.
Strong computer skills and proficiency in Microsoft Office Suite products.
Willingness to travel to local meeting places as needed.
Substantial sales experience.
Knowledge of Medicare/Medicaid and/or nursing community dynamics.
Demonstrate compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code of Conduct.
Demonstrate exceptional interpersonal skills with ability to work independently as well as with a team.
Exceptional organizational skills: strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages.
Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance.
Have suitable home workspace allowing for productive office environment.
Understand the PruittHealth Premier Plan benefits, PruittHealth Premier Plan policies, procedures and articulate them effectively to providers, potential members and key decisions makers.
Complete annual Medicare Fraud, Waste and Abuse Training and Model of Care Training.
Life & Health Insurance License

Nice To Haves

AHIP Certification and Licensed to sell Life and Health insurance in required states to act as an enrollment agent if necessary. (prefer they have this upon hire)

Responsibilities

Serve as a licensed insurance agent to explain Plan benefits and answer potential member resident/responsible party questions.
Coordinate with sales leadership to effectively enroll residents into institutional special needs plans (ISNPs) and dual special needs plans (DSNPs).
Work effectively with sales administration management for as-needed enrollment admin support.
Successfully utilize sales closing skills to drive enrollments, maintaining a strong sale close rate.
Properly follow established sales policies and standard operating procedures, effectively utilizing and updating company systems and databases, including systems for entering referrals and enrollments.
Learn and carry out Centers for Medicare & Medicaid Services rules and regulations.
Meet with potential members/responsible party to ensure that any questions are answered, existing benefits are compared to plan benefits and to act as a point of contact if the potential member or their family needs assistance during the enrollment process.
Offer to participate in facility events for marketing of the plan in accordance with CMS guidelines.
Send monthly lists of upcoming enrollees to facility contacts, agency contacts prior to month end.
Ensure that all interactions with the member are compliant with CMS regulations.
Conduct monthly facility audit in accordance with monthly checklist provided.
Be responsible for a geographic territory of participating nursing facilities and counties for D-SNP marketing and enrollment within that same territory if applicable.
Maintain current license to sell life and health insurance and AHIP certification to maintain employment in this role.