Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
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.
Position Purpose:
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.
Field position working within Suffolk county NY. Fluency in Spanish required.
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
Required to work evenings and weekends
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
Handle complex customer cases and escalated issues, demonstrating advanced problem-solving and empathy
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
Education/Experience:
High School Diploma, or GED, required. Associates Degree or Bachelors Degree preferred. Minimum 1 year health care related experience preferred. Minimum 1 year of customer service or sales experience preferred. Driver’s License may be required by some plans. Specific language skills may be required by some plans.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
