Senior Health Benefit Rep

Centene Management Company • East Tremont, NY

12d • Onsite

About The Position

The Senior Health Benefit Representative (SHBR) educates and assists individuals enrolling in affordable health insurance 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 uninsured individuals and people seeking new coverage, supports existing members with renewals and benefit education, and carries out these activities 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 in the Bronx, New York. The representative is required to work evenings and weekends. The role includes handling complex and escalated cases, maintaining accurate application and lead follow-up records, providing community education, building partnerships, and mentoring staff. Candidates must be authorized to work in the U.S. without current or future employment-based visa sponsorship. Fluency in a second language is highly preferred.

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 all required annual recertification courses and learning requirements.
• Must be authorized to work in the U.S. without the need for current or future employment-based visa sponsorship.
• Must work evenings and weekends.
• Must comply with conflict-of-interest standards and regulations.

Nice To Haves

• Four to five years of prior experience in managed care, sales, customer service, or a related field is preferred.
• Fluency in a second language is highly preferred.
• A driver's license is preferred for NYC counties and mandatory for non-NYC counties.

Responsibilities

• Educate and assist individuals enrolling in Marketplace coverage, 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 how to use Fidelis digital tools, including the member portal and mobile app.
• Explain plan features, benefits, cost-sharing mechanisms, and Marketplace metal tiers.
• Assist consumers with submitting required documents by scan, fax, or mail.
• Support existing members with renewals and recertifications, and assist with premium payment submissions when required.
• Handle complex customer cases and escalated issues with advanced problem-solving and empathy.
• Provide culturally and linguistically appropriate assistance.
• 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, accurate applicant follow-through.
• Review the personal dashboard daily, address potential leads, and follow up on enrollment leads and consumer inquiries.
• Keep abreast of Marketplace functionality to manage individual accounts effectively.
• Record follow-up dispositions accurately and promptly in the required CRM.
• Enter applicant demographic, enrollment site, and PCP selection data in the required CRM at the initial enrollment encounter.
• Comply with conflict-of-interest standards and regulations.
• Mentor new and existing staff, support onboarding and skill development, and serve as a point of contact or team lead when needed.
• Collaborate with leadership and the training team to identify, develop, and implement best practices for community and provider engagement.
• Build and maintain strategic partnerships with providers and community-based organizations.
• Represent Fidelis Care by leading presentations, workshops, and training sessions to enhance provider and community engagement.
• Generate self-sourced leads through community relationships and referrals.
• Safeguard confidential information and prevent unauthorized access to Protected Health Information (PHI).
• Participate in required trainings, updates, webinars, and other forums; complete annual Marketplace Facilitated Enroller (MFE) recertification requirements.
• Keep abreast of 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 assigned duties and comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401(k) and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work, with remote, hybrid, field, or office work schedules
• Additional forms of incentives may be included in total compensation, subject to applicable factors and eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED