State Programs Member Engagement Specialist (Facilitated Enrollment)

About the role

The MarketPlace Facilitated Enroller is responsible for:

• Identifying and educating potential members on all aspects of the plan including new Medicaid, CHP/EP/QHP and answering questions regarding plan’s features and benefits.
• Identifying and assisting current members who are due to recertify their healthcare coverage for Medicaid, EP, QHP and CHP by completing member’s annual recertification application including adding on additional eligible family members.
• Engage in enrollment activities over the phone or in person through onsite coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO’s).
• Complete and review all applications prior to submitting to NYSOH marketplace.
• Aid members with selecting a high-quality Primary Care Physician (PCP), ordering member ID card and making monthly premium payment.
• Manage inbound and outbound telephonic enrollment process as a part of the Sales enrollment. On occasion it may be required to perform this function remotely.
• Educate members about digital tools including HF mobile application, Twilio, as well as NowPow.
• Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures.
• Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually.
• Participate in health-related activities / special events including evening and weekend activities. Events include health fairs, parades, holiday theme events, trade show expos, hospital orientations, provider sponsored events and health related theme events as required based on business needs.
• Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses and Community Based Organization personnel where enrollment activities are conducted. Develop and strengthen relations in order to generate new opportunities for Healthfirst including new sites and event requisitions.
• Maintain current working knowledge of product benefits, formulary, sales system functionality, policies and procedures. Demonstrate working knowledge of regulatory and corporate guidelines.
• Stay abreast on changes to all lines of business to ensure sales business practices are in compliance with Regulatory, marketing guidelines, and overall corporate policies.
• Follow the protocol and guidelines provided by the sales auditing department regarding the schedule and site changes.
• Maintain an adequate supply of marketing materials required to complete the recertification applications as needed.
• Arrive at scheduled work site, and all activity events in accordance to the departmental attendance policy.
• Participate in weekly, bi-weekly and monthly staff meetings, one-on-one meetings with management as well as required training sessions.
• Successfully meet pre and post training, regulatory exams as well as audit requirements.
• Complete annual NYSOH marketplace recertification requirement, Annual Corporate Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA).
• Provide information to management on opportunities at current or potential marketing sites.
• Raise any issues / concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

  Responsibilities

  • Identifying and educating potential members on all aspects of the plan including new Medicaid, CHP/EP/QHP and answering questions regarding plan’s features and benefits.
  • Identifying and assisting current members who are due to recertify their healthcare coverage for Medicaid, EP, QHP and CHP by completing member’s annual recertification application including adding on additional eligible family members.
  • Engage in enrollment activities over the phone or in person through onsite coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO’s).
  • Complete and review all applications prior to submitting to NYSOH marketplace.
  • Aid members with selecting a high-quality Primary Care Physician (PCP), ordering member ID card and making monthly premium payment.
  • Manage inbound and outbound telephonic enrollment process as a part of the Sales enrollment. On occasion it may be required to perform this function remotely.
  • Educate members about digital tools including HF mobile application, Twilio, as well as NowPow.
  • Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures.
  • Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually.
  • Participate in health-related activities / special events including evening and weekend activities. Events include health fairs, parades, holiday theme events, trade show expos, hospital orientations, provider sponsored events and health related theme events as required based on business needs.
  • Establish and maintain good working relationships with external business partners such as hospital and provider organizations, City agencies, small businesses and Community Based Organization personnel where enrollment activities are conducted. Develop and strengthen relations in order to generate new opportunities for Healthfirst including new sites and event requisitions.
  • Maintain current working knowledge of product benefits, formulary, sales system functionality, policies and procedures. Demonstrate working knowledge of regulatory and corporate guidelines.
  • Stay abreast on changes to all lines of business to ensure sales business practices are in compliance with Regulatory, marketing guidelines, and overall corporate policies.
  • Follow the protocol and guidelines provided by the sales auditing department regarding the schedule and site changes.
  • Maintain an adequate supply of marketing materials required to complete the recertification applications as needed.
  • Arrive at scheduled work site, and all activity events in accordance to the departmental attendance policy.
  • Participate in weekly, bi-weekly and monthly staff meetings, one-on-one meetings with management as well as required training sessions.
  • Successfully meet pre and post training, regulatory exams as well as audit requirements.
  • Complete annual NYSOH marketplace recertification requirement, Annual Corporate Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA).
  • Provide information to management on opportunities at current or potential marketing sites.
  • Raise any issues / concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

    Qualifications

    • Knowledge of Medicaid, Essential Plan, Child Health Plus, Qualified Health Plan, Medicare or any other healthcare product line.
    • Basic knowledge of Microsoft Office (Excel, Word and PowerPoint).
    • GED or high school diploma.
    • Bilingual preferred.

    Skills

    • Excellent communication skills.
    • Ability to work independently and as part of a team.
    • Strong organizational and time management skills.
    • Ability to handle multiple tasks and prioritize accordingly.
    • Proficient in Microsoft Office Suite.

    Benefits

    Healthfirst offers a comprehensive benefits package which includes:

    • Medical, dental and vision coverage.
    • Incentive and recognition programs.
    • Life insurance.
    • 401(k) contributions.

    Pay

    Hiring Range: Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070
    All Other Locations (within approved locations): $51,000 - $74,880

    Schedule

    Full-time position.