Health Benefit Rep

Centene Corporation•Remote-NY, NY

2d•$23 - $40•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 100% field-based position working within Dutchess county, New York. Fluency in Spanish is highly preferred. The role requires the individual to be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Requirements

Must have a High School Diploma or GED
Must have basic computer skills
Must have prior Public Speaking experience
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

2+ years of prior experience in managed care, sales, customer service or related experience preferred
Fluency in Spanish highly preferred
Driver's License is preferred for 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