Marketplace Facilitated Enroller I (Greater Rochester Territory)

About the position This role is responsible for identifying prospective members that do not have health insurance, providing education regarding On- and Off-Marketplace health insurance products, assisting in selection of the appropriate health plan and primary care physician, and assisting with the enrollment process. The Marketplace Facilitated Enroller (MFE) is also responsible for assisting current members with recertification in their plan. Products include but are not limited to Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP), Stand Alone Dental and the Individual Market Qualified Health Plan (QHP). All MFEs must conduct themselves in accordance with regulations and instruction set forth by NYS and the Federal government and are expected to meet all defined standards of outreach.

Responsibilities

• Conducts interviews and screens potentially eligible recipients for enrollment into an appropriate health insurance program/product.
• Communicates and reviews health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant’s eligibility.
• Meets with prospects at various sites throughout the communities including in-home as needed.
• Provides critical assessment and analysis which effects insurance enrollment for families and children.
• Collects/reviews family income and household information used to determine eligibility for above named product portfolio including Adjusted Premium Tax Credit (APTC) and Cost Sharing (CS) for individuals and families.
• Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace.
• Identifies and manages enrollment barriers and works with the applicant(s) and the marketplace to resolve enrollment issues.
• Reviews all applications for completeness and accuracy prior to submitting to the marketplace.
• Improves customer retention through on-boarding best practices defined as part of the assistor process.
• Acts as member advocate for the individual to the Marketplace.
• Applies the rules and regulations of the Marketplace to the individual eligibility and provides open communication on application process between the parties.
• Proactively reaches out to local businesses and community agencies/groups within assigned territory to educate and increase awareness of heath care offerings, state regulations, and the Health Plan brand.
• Presents all aspects of eligibility, enrollment and available products to community audiences.
• Establishes trusted relationships with community influencers and grassroots community-based organizations and local agencies.
• Participate in on-site enrollment opportunities (Hospitals, Community Centers, etc.) and health-related activities/special events within assigned territory including evening and weekend activities.
• Attends annual New York State Department of Health (NYSDOH) regional fall enrollment events keeping abreast of new information for upcoming annual enrollment.
• Participates in department business strategy sessions providing input from customer’s point of view and any competitive intelligence collected.
• Recommends process improvement and advises management of any proposed recommendations that can make a workflow or process more efficient.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Requirements

• High School Diploma or equivalent with three or more years of experience in MFE, customer service, sales or related area.
• Experience working for a health insurance company preferred.
• New York State MFE training and certification is required within 3 months of hire.
• Demonstrated knowledge of Child Health Plus, Essential Plan, Medicaid/Medicaid Managed Care, Stand Alone Dental and the Individual Market (Qualified Health Plans) products.
• Demonstrated ability to present to organizations within the community regarding rules and regulations of the health insurance mandate, the enrollment process, and available products.
• Ability to communicate with a diverse clientele in a compassionate, fair, and accurate manner.
• Bilingual preferred.
• Excellent written and oral communication skills.
• Strong attention to detail and capability to meet established productivity and quality standards.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• Familiarity with GoldSNAP client relationship management (CRM) tool and other technical applications.

Nice-to-haves

• Experience working for a health insurance company preferred.
• Bilingual preferred.

Benefits

• group health and/or dental insurance
• retirement plan
• wellness program
• paid time away from work
• paid holidays

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