MetroPlus
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
Scope of Role & Responsibilities
Educational/Enrollment Process
- Educate and provide 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.
- Assist consumers/applicants with calling the NY State of Health Customer Services Department for assistance with enrolling and/or providing verification documentation.
- Conduct public education activities for consumers to raise awareness of available QHPs within Marketplace.
- Explain potential eligibility for public/governmental programs, how the federal health insurance premium tax credit and cost‑sharing reductions work, and outline potential risk factor, if any, to consumers.
- Describe the features and benefits of health insurance coverage, including cost‑sharing mechanisms like deductibles, co‑pays, co‑insurance and how these work and/or affect the consumer.
- Describe the different metal tiers within the Marketplace and how the benefits may change at different tiers based on the consumer’s income.
- Conduct presentations and participate in ACA forums and workshops upon request.
- Assist consumers with submitting documents and information as required by the Marketplace via scan, fax, or mail.
- Assist existing members with recertification, when applicable.
- Assist consumers with the submission of premium payments when required.
Regulatory/Compliance
- Securing and safeguarding confidential information to prevent Protected Health Information (PHI) from being obtained by 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.
Tactical
- 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.
- Maintain a consistent supply of various educational and product line collateral.
- Keep abreast of all Marketplace functionalities to effectively manage individual accounts.
- Conduct a daily review of the MetroPlusHealth “Marketplus” lead management program to follow‑up on all new potential enrollment leads and consumer inquiries. Record all follow‑up dispositions in a timely and accurate manner.
- Data enter all applicant demographic, enrollment site and PCP selection data in the required “Enrollment Program” within the MetroPlusHealth portal at the time of the initial enrollment encounter.
- Must be in compliance with all conflict‑of‑interest standards and regulations.
- All other tasks and responsibilities as may be required to satisfy the expectations of the role.
- Required to work evenings and weekends.
Required Education, Training & Professional Experience
- Must have a High School Diploma or GED.
- Minimum of three (3) years of Sales experience required.
- Prior Public Speaking experience.
Licensure and/or Certification Required
- Must complete and pass the NY State of Health approved training program and become certified. Must complete all required annual recertification as an MFE.
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication