Health Benefit Rep

Centene Management Company•Rego Park, NY

5d•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 HBR engages prospective members who are uninsured or seeking new coverage and supports existing members with renewals and benefit education. Activities are performed in compliance with the Affordable Care Act (ACA), FE Integrity Guidelines, Regulatory Guidelines, and Fidelis Care Standards, with a focus on customer experience and community engagement. This is a field-based position working within Queens County, New York. Fluency in Russian or Georgian is highly preferred. The role requires evening and weekend work. Employees must be authorized to work in the U.S. without current or future employment-based visa sponsorship. The HBR maintains detailed activity tracking, monitors and follows up on enrollment applications and leads, records dispositions and applicant information in the required CRM, and stays current on Marketplace functionality and regulatory updates. The role also requires safeguarding confidential information and participating in required training and annual Marketplace Facilitated Enroller recertification.

Requirements

High school diploma or GED.
Basic computer skills.
Prior public speaking experience.
Must complete and pass the NY State of Health-approved training program and become certified.
Must complete required annual recertification courses and learnings.
Must be authorized to work in the U.S. 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 field.
Fluency in Russian or Georgian.
Driver's license preferred for NYC counties; mandatory for non-NYC counties.

Responsibilities

Educate and assist individuals with enrollment in NY State of Health Marketplace coverage, including Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans, and Health & Recovery Plan.
Explain public-program eligibility, federal premium tax credits, cost-sharing reductions, and potential impacts to consumers.
Teach members how to use Fidelis digital tools, including the member portal and mobile app.
Describe plan features, benefits, cost-sharing mechanisms, and Marketplace metal tiers and how benefits 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 public education about Fidelis Care products and Marketplace options.
Participate in ACA forums, workshops, and community events as requested.
Maintain a daily tracking tool with detailed representative activity.
Monitor applications in a personal dashboard and follow up in a timely and accurate manner on applications, potential leads, and consumer inquiries.
Keep abreast of Marketplace functionality to manage individual accounts effectively.
Record follow-up dispositions and enter applicant demographic, enrollment site, and PCP selection data in the required CRM at the initial enrollment encounter.
Safeguard confidential information and protect PHI from unauthorized access; comply with privacy, security, conflict-of-interest, and other applicable standards and regulations.
Participate in required trainings, updates, webinars, and other forums; complete the approved NY State of Health training and annual MFE recertification requirements.
Maintain discretion regarding business-related files, reports, and conversations, and perform other duties as assigned.