Senior Health Benefit Rep

Centene Management Company•New York City, NY

5d•Onsite

About The Position

The Senior Health Benefit Representative (SHBR) 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 field position working within the communities of downstate New York, including Queens, Brooklyn, Bronx, Manhattan, Westchester, Nassau, and Suffolk. Qualified candidates must live within driving distance of one of the previously mentioned areas as this position is fully field based. Multilingual or fluency in either Spanish, Russian, Bengali, Polish, Chinese, or Georgian is preferred. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Requirements

Must have a High School Diploma or GED
4 to 5 years prior experience in managed care, sales, customer service or related experience preferred.
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

Multilingual or fluency in either Spanish, Russian, Bengali, Polish, Chinese, or Georgian is preferred.
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.
Handle complex customer cases and escalated issues, demonstrating advanced problem-solving and empathy.
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.
Serve as a mentor new/existing staff, supporting onboarding and skill development.
Serve as point of contact or team lead when necessary, providing guidance and coordination.
Collaborate with leadership and training team to identify, develop, and implement best practices that enhance community & provider engagement.
Build and maintaining strategic partnerships with providers and community-based organizations (CBOs).
Represent Fidelis Care with professionalism by leading presentations, workshops, and training sessions, enhancing provider and community engagement.
Generate self-sourced leads through strong community relationships and referrals.
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.