Field Health Benefit Rep

Centene Management Company•Utica, NY

12d•Onsite

About The Position

The Health Benefit Representative (HBR) educates and assists individuals with enrolling in affordable health insurance 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). The role engages prospective members who are uninsured or seeking new coverage and supports existing members with renewals and benefit education. Work is performed in compliance with the Affordable Care Act (ACA), FE Integrity Guidelines, regulatory guidelines, and Fidelis Care standards, with an emphasis on customer experience and community engagement. This is a field-based position working within Oneida County, New York. The representative is required to work evenings and weekends. Fluency in a second language is highly preferred. The representative must be authorized to work in the United States without current or future employment-based visa sponsorship. The representative must complete and pass the NY State of Health-approved training program and become certified, and must complete required annual recertification courses and learning. A high school diploma or GED is required. Two or more years of experience in managed care, sales, customer service, or a related area is preferred. Basic computer skills and prior public-speaking experience are required. A driver’s license is preferred for NYC counties and mandatory for non-NYC counties. The listed pay range is $23.23–$39.61 per hour. Actual pay may vary based on skills, experience, education, and other job-related factors, including full-time or part-time status. Total compensation may include incentives. Centene offers competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements. Benefits may be subject to program eligibility.

Requirements

High school diploma or GED.
Basic computer skills.
Prior public-speaking experience.
Complete and pass the NY State of Health-approved training program and obtain certification.
Complete all required annual recertification courses and learning.
Driver’s license is mandatory for non-NYC counties; preferred for NYC counties.
Must be authorized to work in the United States without current or future employment-based visa sponsorship.
Must work evenings and weekends.

Nice To Haves

Two or more years of prior experience in managed care, sales, customer service, or a related area.
Fluency in a second language.
Driver’s license for NYC counties.

Responsibilities

Educate and assist individuals enrolling in coverage through the NY State of Health Marketplace, including Medicaid, Child Health Plus, the Essential Plan, Qualified Health Plans, and Health & Recovery Plan.
Explain eligibility for public programs, federal premium tax credits, and cost-sharing reductions, including potential impacts to consumers.
Teach members about Fidelis digital tools, including the member portal and mobile app.
Describe plan features, benefits, cost-sharing mechanisms, and Marketplace metal tiers, including how benefits may vary by income level.
Assist consumers with submitting required documents by scan, fax, or mail.
Support existing members with renewals and recertifications.
Help consumers submit premium payments when required.
Provide culturally and linguistically appropriate assistance and information.
Conduct public education activities and presentations about Fidelis Care products and Marketplace options; participate in ACA forums, workshops, and community events as requested.
Maintain a daily activity-tracking tool and monitor the personal dashboard to ensure timely and accurate applicant follow-through.
Review the personal dashboard daily and follow up on potential leads and consumers seeking assistance.
Keep current with Marketplace functionalities to effectively manage individual accounts.
Follow up on new enrollment leads and consumer inquiries, and record dispositions accurately and promptly in the required CRM.
Enter applicant demographic, enrollment-site, and PCP-selection data in the required CRM during the initial enrollment encounter.
Comply with conflict-of-interest standards and regulations.
Safeguard confidential information and protected health information from unauthorized access, in accordance with privacy and security standards.
Participate in required trainings, updates, webinars, and other forums; meet annual Marketplace Facilitated Enroller recertification requirements.
Keep current with industry and regulatory updates related to the ACA and Marketplace.
Maintain discretion regarding business-related files, reports, and conversations in accordance with applicable state and federal statutes and regulations.
Perform other duties as assigned and comply with all policies and standards.