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MetroPlusHealth is dedicated to delivering exceptional healthcare services to the diverse communities of New York City, encompassing Bronx, Brooklyn, Manhattan, Queens, and Staten Island. Our extensive range of offerings includes New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. As a proud subsidiary of NYC Health + Hospitals, the largest public health system in the nation, MetroPlusHealth boasts a network of over 27,000 primary care providers, specialists, and clinics. For over three decades, we have focused on fostering strong connections with our members and providers, empowering New Yorkers to achieve their best health.
Position Overview
The Medicare Sales Consultant II plays a crucial role in guiding and supporting eligible individuals in acquiring affordable health insurance options and determining eligibility for coverage in Qualified Health Plans (QHPs) and various insurance affordability programs, including Medicaid and Child Health Plus (CHP) through the NY State of Health (Marketplace). This position involves identifying and educating potential members who are uninsured or seeking to change their coverage, as well as assisting current members with recertification and benefits education. The Medicare Sales Consultant II is expected to perform all responsibilities in compliance with the Affordable Care Act (ACA) and relevant regulations.
Key Responsibilities
Educational/Enrollment Process
- Provide education and assistance to qualified individuals applying for coverage through the NY State of Health Marketplace in a Qualified Health Plan (QHP) and insurance affordability programs such as Medicaid and Child Health Plus.
- Support consumers/applicants in contacting the NY State of Health Customer Services Department for enrollment assistance and verification documentation.
- Conduct public outreach initiatives to raise awareness of available QHPs within the Marketplace.
- Clarify potential eligibility for public/governmental programs, explain the federal health insurance premium tax credit and cost-sharing reductions, and outline any potential risks to consumers.
- Detail the features and benefits of health insurance coverage, including cost-sharing mechanisms like deductibles, co-pays, and co-insurance, and how these affect consumers.
- Explain the different metal tiers within the Marketplace and how benefits may vary based on the consumer's income.
- Facilitate presentations and participate in ACA forums and workshops as requested.
- Assist consumers in submitting required documents and information to the Marketplace via scan, fax, or mail.
- Support existing members with recertification when necessary.
- Help consumers with premium payment submissions when required.
- Ensure the security and confidentiality of sensitive information to protect Protected Health Information (PHI) from unauthorized access, maintaining compliance with privacy and security standards.
- Deliver information in a culturally and linguistically appropriate manner to meet the needs of the population served by the Marketplace.
- Engage in all necessary training, updates, webinars, and forums to fulfill job responsibilities.
- Meet the annual Marketplace Facilitated Enroller (MFE) recertification requirements.
- Stay informed about industry and regulatory updates related to the ACA and Marketplace.
- Maintain confidentiality regarding business-related files, reports, and discussions in accordance with applicable State and Federal laws.
- Utilize a daily tracking tool to document detailed representative activities.
- Monitor all applications in the personal dashboard to ensure timely and accurate follow-up with applicants.
- Conduct daily reviews of the personal dashboard to address and follow up on potential leads for consumers seeking assistance.
- Maintain an adequate supply of educational and product collateral.
- Stay updated on all Marketplace functionalities to effectively manage individual accounts.
- Review the MetroPlusHealth "Marketplus" lead management program daily to follow up on new enrollment leads and consumer inquiries, recording all follow-up actions promptly.
- Input all applicant demographic, enrollment site, and PCP selection data into the required "Enrollment Program" within the MetroPlusHealth portal during the initial enrollment encounter.
- Perform any additional tasks and responsibilities as needed to meet the expectations of the role.
- High School Diploma or GED required.
- At least three (3) years of experience in Sales/Customer Relations.
- Experience in Public Speaking.
- Compliance with all conflict-of-interest standards and regulations is mandatory.
- Availability to work evenings and weekends is required.
- Completion and passing of the NY State of Health approved training program and certification are mandatory. Annual recertification as an MFE is required.
- Integrity and Trust
- Customer Focus
- Functional/Technical Skills
- Written/Oral Communication
