Community Connections Representative I/II (Rochester)
Excellus BCBS, Rochester, NY, United States
Community Connections Representative I/II (Buffalo and Rochester)
Join to apply for the
Community Connections Representative I/II (Buffalo and Rochester)
role at
Excellus BCBS
This position assists the health plan in establishing a community presence through home visits and outreach, bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources, help navigate available resources, and provide assistance with addressing social‑determinants‑of‑health barriers and care gaps. They also educate and assist with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): on‑ and off‑marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market – Qualified Health Plan (QHP).
The role requires occasional evenings and weekends for outreach and community events, and the ability to drive independently within the health plan regions.
Essential Accountabilities Level I
Educates Medicaid, Medicare, and Commercial members on healthcare benefits and community resources through home visits and outreach.
Assists members with accessing care, Case Management programs, benefits, and government cell‑phone programs.
Coordinates, plans, and attends community events, including school events, health fairs, and various community initiatives; proactively informs and increases awareness of health‑care offerings, state regulations, and the Excellus/Univera brand/products within assigned territories.
Completes scheduled and unscheduled home visits for non‑compliance, gaps in care, community resource needs, and other high‑risk issues.
Conducts targeted phone calls for compliance, HEDIS initiatives, and health risk assessments.
Collaborates with Case Management on the status of high‑risk member referrals.
Assists in finding and connecting members to community social services and agencies; enrolls or refers qualified members to a health home.
Communicates health‑insurance program options and fundamentals of all products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace.
Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as required by the Marketplace.
Interprets complex instructions from the MFE Training Manual to assist applicants; provides critical assessment and analysis affecting insurance enrollment for families and children; presents all aspects of eligibility, enrollment, and available products to community audiences.
Meets with applicants in locations with additional MFE resource backup.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Level II (in addition to Level I Essential Accountabilities)
Manages incoming Community Connections referrals.
Maintains the Community Resource Guide as needed.
Ensures educational materials and supplies are replenished and available for use.
Maintains the in‑house food pantry, ensuring all non‑perishable items are within use‑by date.
Works with management to participate in training processes for new hires and team refreshers; supervises interns and/or mentors new hires, providing first‑level problem resolution and sharing Lifetime Way cultural expectations to ensure successful onboarding and engagement.
Works with management to establish influential relationships in the community within assigned territory.
Attends community IPA/Navigator agency as instructed.
Represents the company in small and large community‑based organization meetings as required or in collaboration with the Community Engagement Program Manager.
Gains subject‑matter‑expertise (SME) level in key focus area; develops training curriculum and facilitates workshops for the team in conjunction with management.
Minimum Qualifications NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
High school diploma or GED required; associate degree preferred.
Minimum of two years of social services, community outreach, or education experience required.
Marketplace Facilitated Enroller certification preferred.
Demonstrated problem‑solving, interpersonal, and communication skills.
Prior experience and working knowledge in Microsoft Suite, including Excel and Word.
Level II (in addition to Level I Minimum Qualifications)
Minimum of two years’ experience working in the Community Connections Representative role.
Marketplace Facilitated Enroller certification required; maintaining certification through continuing education/training is essential.
Demonstrated attention to detail.
Demonstrated leadership skills.
Demonstrated knowledge and experience of the healthcare industry and health‑plan business.
Demonstrated ability to organize and represent an organization at community events preferred.
Highly effective communicator.
Physical Requirements
Ability to work in a home office for continuous periods of time for business continuity.
Ability to travel across the health‑plan service region for meetings and/or trainings as needed.
Ability to lift, carry, push, or pull 15 pounds or less.
Reaching, crouching, stooping, kneeling required.
Must have a valid Class D license and ability to operate a motor vehicle.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Equal Opportunity Employer Compensation Range(s) Level I: Grade N4: Minimum $19.22 – Maximum $30.76
Level II: Grade N5: Minimum $20.02 – Maximum $33.03
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill, and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be an opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case‑by‑case basis.
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Community Connections Representative I/II (Buffalo and Rochester)
role at
Excellus BCBS
This position assists the health plan in establishing a community presence through home visits and outreach, bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources, help navigate available resources, and provide assistance with addressing social‑determinants‑of‑health barriers and care gaps. They also educate and assist with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): on‑ and off‑marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market – Qualified Health Plan (QHP).
The role requires occasional evenings and weekends for outreach and community events, and the ability to drive independently within the health plan regions.
Essential Accountabilities Level I
Educates Medicaid, Medicare, and Commercial members on healthcare benefits and community resources through home visits and outreach.
Assists members with accessing care, Case Management programs, benefits, and government cell‑phone programs.
Coordinates, plans, and attends community events, including school events, health fairs, and various community initiatives; proactively informs and increases awareness of health‑care offerings, state regulations, and the Excellus/Univera brand/products within assigned territories.
Completes scheduled and unscheduled home visits for non‑compliance, gaps in care, community resource needs, and other high‑risk issues.
Conducts targeted phone calls for compliance, HEDIS initiatives, and health risk assessments.
Collaborates with Case Management on the status of high‑risk member referrals.
Assists in finding and connecting members to community social services and agencies; enrolls or refers qualified members to a health home.
Communicates health‑insurance program options and fundamentals of all products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace.
Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as required by the Marketplace.
Interprets complex instructions from the MFE Training Manual to assist applicants; provides critical assessment and analysis affecting insurance enrollment for families and children; presents all aspects of eligibility, enrollment, and available products to community audiences.
Meets with applicants in locations with additional MFE resource backup.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Level II (in addition to Level I Essential Accountabilities)
Manages incoming Community Connections referrals.
Maintains the Community Resource Guide as needed.
Ensures educational materials and supplies are replenished and available for use.
Maintains the in‑house food pantry, ensuring all non‑perishable items are within use‑by date.
Works with management to participate in training processes for new hires and team refreshers; supervises interns and/or mentors new hires, providing first‑level problem resolution and sharing Lifetime Way cultural expectations to ensure successful onboarding and engagement.
Works with management to establish influential relationships in the community within assigned territory.
Attends community IPA/Navigator agency as instructed.
Represents the company in small and large community‑based organization meetings as required or in collaboration with the Community Engagement Program Manager.
Gains subject‑matter‑expertise (SME) level in key focus area; develops training curriculum and facilitates workshops for the team in conjunction with management.
Minimum Qualifications NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
High school diploma or GED required; associate degree preferred.
Minimum of two years of social services, community outreach, or education experience required.
Marketplace Facilitated Enroller certification preferred.
Demonstrated problem‑solving, interpersonal, and communication skills.
Prior experience and working knowledge in Microsoft Suite, including Excel and Word.
Level II (in addition to Level I Minimum Qualifications)
Minimum of two years’ experience working in the Community Connections Representative role.
Marketplace Facilitated Enroller certification required; maintaining certification through continuing education/training is essential.
Demonstrated attention to detail.
Demonstrated leadership skills.
Demonstrated knowledge and experience of the healthcare industry and health‑plan business.
Demonstrated ability to organize and represent an organization at community events preferred.
Highly effective communicator.
Physical Requirements
Ability to work in a home office for continuous periods of time for business continuity.
Ability to travel across the health‑plan service region for meetings and/or trainings as needed.
Ability to lift, carry, push, or pull 15 pounds or less.
Reaching, crouching, stooping, kneeling required.
Must have a valid Class D license and ability to operate a motor vehicle.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Equal Opportunity Employer Compensation Range(s) Level I: Grade N4: Minimum $19.22 – Maximum $30.76
Level II: Grade N5: Minimum $20.02 – Maximum $33.03
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill, and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be an opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case‑by‑case basis.
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