Health Benefit Rep

Centene Management Company•Rego Park, NY

8d•Remote

About The Position

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. This is a community field-based travel position covering Queens County, NY. The role involves educating prospects and members on New York State of Health coverage options, supporting new enrollments and renewals, and prioritizing enrollment growth through trust and accountability. The HBR will explain eligibility for public programs, federal premium tax credits, and cost-sharing reductions, teach members about Fidelis digital tools, describe plan features, benefits, and cost-sharing mechanisms, and explain metal tiers within the Marketplace. Assistance with submitting required documents, premium payments, and providing culturally and linguistically appropriate support are key functions. The role also includes conducting public education activities, participating in ACA forums, workshops, and community events, and maintaining a daily tracking tool and personal dashboard for leads and applications. The HBR must stay updated on Marketplace functionalities, follow up on leads and inquiries, and record all dispositions accurately in the CRM. Data entry of applicant information is also required. Compliance with conflict-of-interest standards, safeguarding confidential information, and participating in all required trainings and recertification are mandatory. The position requires performing other duties as assigned and complying with all policies and standards.

Requirements

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
Must complete and pass the NY State of Health approved training program and become certified.
Must complete all required annual recertification courses/learnings.

Nice To Haves

Bilingual – English/Spanish Highly Preferred and all other second languages
Community Outreach
Front Facing Field Sales
CAC Certification preferred
MS Office Suite
Salesforce
Driver's License: Preferred for NYC counties, Mandatory for non-NYC counties

Responsibilities

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.
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.