Program Coordinator

The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.

The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.

The Exchange embraces the following equity statement adopted by our Board of Directors:

Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.

SUMMARY

This position supports the Conditional Eligibility Verification (CEV) and Appeals programs and provides excellent service to customers with escalated issues regarding eligibility.

Customers who are conditionally eligible (for coverage or for financial assistance) must provide documents to verify certain information attested in their Healthplanfinder application. The CEV team must ensure these customers receive letters explaining which documents we need, provide instructions for the customers to upload or send the documents, set due dates for response, and take further action based on whether the customer responds. 

Healthplanfinder applicants and enrollees have the right to appeal eligibility determinations when they believe the eligibility is wrong. Employers have the right to appeal when an employee reports in Healthplanfinder that the employer did not offer affordable health insurance. An appeal is a legal process and a Presiding Officer (judge) issues a ruling in the matter. Individual appellants, employer appellants, and employees involved in employer appeals contact the Appeals Program for assistance.

The Program Coordinator will explain basic eligibility requirements per federal regulations, state law, and Exchange policies and procedures to customers who may have minimal understanding of health insurance eligibility. The Program Coordinator independently assesses customers’ issues and either resolves the issue by providing the resources, explanation, and/or additional information the customer needs, or escalating the issue to an Eligibility or Appeals Specialist, or an Analyst, Supervisor or Manager on the Eligibility team or on another team. 

DUTIES AND RESPONSIBILITIES

•    Serve as a Healthplanfinder expert, including understanding of the major tracks (i.e. eligibility, enrollment, Customer Support, plan management, etc.)

•    Manage the CEV and Appeals programs’ Outlook accounts by returning phone calls, responding to emails, uploading documents to Healthplanfinder, and processing appeal requests within agreed upon timelines, or directing calls, emails, and faxes to appropriate staff or team.

•    Manage documents received via USPS by scanning, uploading, distributing, or processing in accordance with established processes.

•    Explain complex federal regulations, state laws, and Exchange policies and procedures to customers. Keep current with changes in laws, regulations, and Exchange policies and procedures.

•    Update customers’ Healthplanfinder information upon request.  

•    Use multiple complex database systems effectively, including the Appeals System (TAS), the CEV Workload Management Tool (WMT), Healthplanfinder and suite (AWP/CSA), and Zendesk. Keep up to date on system defects, workarounds and updates.

•    Perform account analysis and explain findings to customers in words they can understand. Offer options for resolution, as appropriate, and submit or assign tickets for escalated matters. 

•    Participate in Eligibility team, Operations, and Exchange meetings to learn about emerging issues and customer trends, and to explore opportunities for process improvements. 

•    Perform clerical duties including but not limited to preparing mailings, maintaining logs, updating case management systems, typing, scanning, posting, emailing and mailing.

•    Perform tasks associated with special projects assigned to the Eligibility team, which may include but aren’t limited to tracking issues, reviewing documents, and updating/correcting information in Healthplanfinder.

•    Other duties as required.  

Appeals

•    Assist customers with the appeal request process. Explain what can be appealed, provide forms, instructions, and respond to questions about the process in accordance with federal regulations, state laws, and Exchange policies and processes.

•    Assist employers with the employer appeal process. Explain what can be appealed, provide forms, instructions, verification of an employee’s attestation and eligibility, and respond to questions about the process in accordance with federal regulations, state laws, and Exchange policies and processes. 

•    Respond to emails from the US Health and Human Services (HHS) 2nd level appeals administrator, compiling documents and sending through secure electronic interface when instructed.

•    Enter appeal data accurately into case management system. Confirm when appeals are received and provide appellants with required information and documentation associated with filing an appeal.

Conditional Eligibility Verification

•    Explain complex federal requirements to customers who don’t understand why they need to provide documents and explain the potential changes to eligibility if documents aren’t provided.

•    Effectively use the Workload Management Tool (WMT) to send reminder letters in accordance with Exchange policies and procedures. 

•    Reset or extend customers’ due dates, as needed and according to Exchange policies and procedures, and explain to customers why their due dates were extended or why they weren’t.

•    Perform some document review to manually verify or manually fail specific categories, as needed to support customers and Eligibility Specialists; assign complex document review to an Eligibility Specialist.

QUALIFICATIONS

Required:

•    High School diploma, or equivalency.

•    Three years of experience providing customer service or working in a call center in a state or federal government agency, health Insurance or financial industry.

•    Proficient in Microsoft Office Software, Including Outlook, Word, Excel, SharePoint, and PowerPoint.

•    Ability to adapt, handle, and prioritize workload. Able to respond to customer issues within established timelines.

•    Demonstrated success maintaining professionalism in challenging situations.

•    Experience handling confidential information.

•    Use an interpreter to assist customers with limited English proficiency.

•    Self-motivated with the ability to manage workload independent of immediate supervision while still meeting agreed upon deadlines and work quality.

•    Willingness to ensure the success of team by providing administrative support and assistance to program staff.  

Desired:

•    Basic understanding of health insurance landscape, WA Healthplanfinder, Apple Health and Qualified Health Plan eligibility. Able to communicate requirements for eligibility to customers and triage on a case-by-case basis.

•    Fluent in Spanish and certified by a recognized interpreter-services organization (e.g. DSHS certified, court certified). 

•    Three years of experience explaining and applying complex regulations, laws, and policies.

APPLICATION INSTRUCTIONS

This position will be open until we find a suitable number of candidates to review. If interested, please submit an application with a cover letter as soon as possible. The Exchange reserves the right to close the recruitment at any time. 

SALARY INFORMATION

The hiring salary range is between minimum of $54,452.00 and the midpoint of $59,187.00 depending on candidate experience, internal equity, and the market.  Our compensation policy reserves the salary range above the midpoint for meeting and exceeding expectations and growth and development, up to the maximum of $71,024.00.

BENEFITS

Take a peek at our benefits package.

WORKING CONDITIONS

Core business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. There are times where irregular hours will be required.  The preferred duty station is our Olympia, Washington headquarters.  The nature of this role relies heavily on remote and in-person collaboration.  While a hybrid remote and on-site schedule may be considered, the position will require flexibility to allow for in-office availability as business needs dictate. Travel requirements will be limited, however there may be occasions where an employee is required to travel and work irregular hours to attend meetings or trainings. Duties of this position require the use of standard office furniture and equipment, including setup for remote work. The employee is responsible for providing and maintaining a safe, ergonomic, and secure workspace at their remote location.   

The working conditions and physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SPECIAL REQUIREMENTS

A criminal background screen will be conducted for candidates under final consideration, and if hired, every five years of employment where highly sensitive data is processed or maintained by the position. The result of this background screen must meet the Exchange’s eligibility standards.

OTHER INFORMATION

The above statements are intended to describe the general nature and levels of work being performed.  They are not intended to be construed as an exhaustive list of responsibilities, duties and skills of personnel so classified.

This is not an employment agreement or contract.  Management has the exclusive right to alter this job description at any time without notice.

The Washington Health Benefit Exchange is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We participate in E-Verify. You can view the Department of Justice's Right to Work poster here.