Health Insurance Enrollment Specialist

VARIETY CARE INC•Oklahoma City, OK

23d•Onsite

About The Position

The Certified Application Counselor (CAC) assists clients with online applications and enrollment for SoonerCare, Soon To Be Sooners, and health insurance options available through the Affordable Care Act (ACA) Marketplace. The role provides individual clients with education about health insurance and SoonerCare and promotes awareness of available coverage through outreach and in-reach activities, including collaboration with the Variety Care Billing Department and providing information to WIC classes. The counselor provides fair, accurate, impartial, culturally and linguistically appropriate enrollment assistance; determines whether clients may apply for Medicaid or ACA Exchange coverage; and helps eligible clients complete enrollment, set up Marketplace accounts, apply for subsidies, and select coverage. The counselor educates clients about coverage terminology, premiums, co-pays, coverage options, subsidies, and tax credits, while ensuring clients make their own informed plan selections. The position also assists with follow-up, Marketplace exemptions and appeals, identifies and coordinates resolution of enrollment barriers, makes referrals, and completes internal documentation and reporting. The role supports Variety Care’s Patient Centered Medical Home approach and its commitment to safe, effective, patient-centered, timely, efficient, and equitable care. It collaborates toward the healthcare reform “Triple Aim”: improving patients’ experience of care and health outcomes while decreasing costs. The counselor is expected to demonstrate integrity, adaptability, sound judgment, accountability, and leadership in the department and community, and performs other duties as assigned.

Requirements

High school diploma or GED.
Complete Certified Application Counselor (CAC) training and receive certification.
Register with the Oklahoma Insurance Department as a Navigator.
Experience using a computer.
Basic communication skills.
Experience handling confidential information.
Valid driver’s license and reliable transportation.
Able to lift a minimum of 25 pounds.
Able to drive to Variety Care sites and outreach locations.

Nice To Haves

Post-secondary education.
Experience in community outreach work.
Experience with SoonerCare Agency View.
Bilingual in English and Spanish.

Responsibilities

Maintain expertise in Health Insurance Marketplace and SoonerCare eligibility and enrollment rules and procedures.
Provide fair, accurate, impartial, culturally and linguistically appropriate information and enrollment assistance.
Determine whether clients are eligible to apply for Medicaid or ACA Exchange coverage.
Enroll eligible clients in SoonerCare, Soon To Be Sooners, or other available Medicaid programs in accordance with OHCA rules using Agency View.
Help clients set up Marketplace accounts, apply for subsidies, and navigate the health insurance application process.
Educate clients about insurance terminology and responsibilities, including premiums, co-pays, coverage options, subsidies, and individual tax credits.
Help clients make their own informed selections from Marketplace coverage options without recommending a specific plan.
Follow up with clients as needed to support completion of enrollment.
Assist clients with Marketplace exemptions and appeals.
Identify internal enrollment barriers and coordinate with Variety Care staff to resolve them.
Identify external enrollment barriers and share them with the Variety Care enrollment team.
When appropriate, inform clients about Variety Care medical, dental, behavioral health, WIC, and support services and facilitate appointments.
Conduct public education and outreach to raise awareness of Medicaid, Marketplace coverage, and enrollment assistance available at Variety Care.
Refer clients to Variety Care and external social services resources as appropriate.
Complete internal ECW and other assigned documentation and reporting.
Support Variety Care’s Patient Centered Medical Home approach and commitment to safe, effective, patient-centered, timely, efficient, and equitable care.
Collaborate to improve patients’ experience of care and health outcomes and decrease healthcare costs.
Demonstrate personal character, open and honest communication, ethical conduct, integrity, adaptability, sound judgment, leadership, and accountability.
Perform other duties as assigned.