State Program Member Engagement Specialist

3 weeks ago

New York NY US Healthfirst Full time

The Marketplace Facilitated Enroller is responsible for identifying prospective members that do not have health insurance and enroll them into one of the government programs offered by Healthfirst such as Medicaid, Child Health Plus (CHP), Essential Plan (EP) or a Qualified Health Plan (QHP). The Marketplace FE is also responsible for assisting current Healthfirst members by recertifying them into Medicaid, EP, QHP or CHP. Marketplace Facilitated Enrollers are required to travel frequently throughout the NYC boroughs, Nassau and Suffolk counties.

  • Identify and educate potential members on all aspects of the plan including answering questions regarding plan's features and benefits. Responsible for 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 additional eligible family members.
  • Refer all existing members up for recertification to an onsite Retention Specialist when applicable.
  • Assist members with selecting a Primary Care Physician (PCP) using the Healthfirst provider directory via the provider search tool. This includes verifying the correct PCP in OnContact and making any necessary changes based on member's request.
  • Always maintain an adequate Book of Business (BOB), while adhering to the BOB policies and procedures. Complete enrollment activity through the NYSOH marketplace.
  • Meet application goals while adhering to regulatory and state compliance. Enrollment activities include on site coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO's). All activity entered in Saleslogix (SLX) and PHSP Tracker tool.
  • Conduct home visits and other appointments as needed to complete the application and obtain all required documentation.
  • Review all applications prior to submitting to NYSOH marketplace. Complete a Conflict of Interest (COI) form and Marketplace Facilitated Enroller Disclosure & Applicant Authorization Form (PII) via Docusign for every enrollment encounter. Raise any additional training needs to management.
  • Maintain an adequate supply of renewal materials required to complete the recertification applications.
  • Always maintain and carry Conflict of Interest (COI) forms.
  • Successfully meet pre and post training and regulatory exams and audit requirements.
  • Complete annual NYSOH marketplace recertification requirement and complete Annual Corporate
  • Compliance and Sexual Harassment Training requirements and any required training from City Department of Health (CDOH) or Human Resources Administration (HRA). Understand and implement the Plan's policies and procedures for the facilitated enrollment and renewal process.
  • 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 to generate new opportunities for Healthfirst including new sites and event requisitions.
  • 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.
  • Arrive at scheduled work site, team meetings, training sessions and events in accordance with departmental policy.
  • Notify the manager and Sales Audit Department when closing a site in accordance with the Sales Operation policy. Participate in weekly, bi-weekly and monthly staff meetings and training including one-on-one meetings with management.
  • Provide information to management on opportunities at current or potential marketing sites. Raise any issues/concerns to management relative to site coverage, competition, training needs and process improvement.
  • Remain knowledgeable of competitor's products, marketing practices and keep management informed of such products and practices.
  • Recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

Minimum Qualifications:

  • High School Diploma or GED Equivalent
  • Bilingual as needed
  • Experience in customer service
  • Vehicle with valid proof of insurance depending on territory

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not , or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range:

Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960All Other Locations (within approved locations): $49,795 - $72,800
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

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