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Medicare Special Needs Plan Enrollment Specialist

2 months ago

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About the Role

PruittHealth is seeking a highly skilled and experienced Medicare Special Needs Plan Enrollment Specialist to join our team. As a key member of our sales team, you will play a critical role in explaining Plan benefits and answering questions of potential members or their responsible party.

Key Responsibilities
  1. Enrollment and Sales: Serve as a licensed insurance agent to explain Plan benefits and answer potential member resident/responsible party questions.
  2. Lead Coordination: Coordinate with sales leadership to effectively enroll residents into institutional special needs plans (ISNPs); and dual special needs plans (DSNPs).
  3. Administrative Support: Work effectively with sales administration management for as-needed enrollment admin support.
  4. Sales Closing: Successfully utilize sales closing skills to drive enrollments, maintaining a strong sale close rate.
  5. Policy Adherence: Properly follow established sales policies and standard operating procedures, effectively utilizing and updating company systems and databases, including systems for entering referrals and enrollments.
  6. Regulatory Compliance: Ability to learn and carry out Centers for Medicare & Medicaid Services rules and regulations.
  7. Member Support: Meet with potential members/responsible party to ensure that any questions are answered, existing benefits are compared to plan benefits and to act as a point of contact if the potential member or their family needs assistance during the enrollment process.
  8. Marketing and Outreach: Offer to participate in facility events for marketing of the plan in accordance with CMS guidelines.
  9. Reporting and Communication: Send monthly lists of upcoming enrollees to facility contacts, agency contacts prior to month end.
  10. Compliance and Auditing: Ensure that all interactions with the member are compliant with CMS regulation and conduct monthly facility audit in accordance with monthly checklist provided.
  11. Territorial Responsibility: The Enrollment Agent will be responsible for a geographic territory of participating nursing facilities and counties for D-SNP marketing and enrollment within that same territory if applicable.
  12. Licensure and Certification: Maintain current license to sell life and health insurance and AHIP certification to maintain employment in this role.
Requirements
  • Education: Bachelors degree required.
  • Experience: 2 years health insurance sales experience preferred.
  • Licensure: Life & Health Insurance License required.
  • Certification: AHIP Certification and Licensed to sell Life and Health insurance in required states to act as an enrollment agent if necessary.