Account Specialist

Overview

The Account Specialist is responsible for identifying prospective members who do not have health insurance, determining the appropriate plan for the individual or family, and enrolling them into Healthfirst programs such as Medicaid, CHP, EP, QHP, Medicare, or Complete Care. The role regularly works away from Healthfirst’s place of business and collaborates with the Delivery Services Engagement (DSE) team to identify provider-related issues, address and resolve them, promote Healthfirst, and increase market share. The position also involves recertifying members into Medicaid, CHP, EP, and QHP. This role markets exclusively in Westchester County.
Responsibilities

Identify potential members and educate them on health benefits and care tailored to their needs, including features and benefits of specific plans.
For existing members, review current benefits to determine the appropriate plan, assist with recertification of existing coverage, and suggest transfers to other plans aligned with the member’s care. Provide guidance and assistance to recertify healthcare coverage for Medicaid, CHP, EP, QHP, Medicare, or Complete Care, including adding eligible family members.
Assist members with selecting a high-quality Primary Care Physician (PCP), ordering member ID cards, and making monthly premium payments. Use the Healthfirst provider directory, verify information in Salesforce/Member 360/OnContact/BizTalk before making changes based on member requests.
Conduct group educational seminars/presentations on Healthfirst products and preventive care, in person or virtually.
Educate members about digital tools including HF mobile application, Twilio, and NowPow.
Maintain and complete an adequate Book of Business (BOB) for all encounters and leads daily, adhering to BOB policies and procedures.
Identify and develop business opportunities within assigned territories.
Conduct monthly group presentations targeting small businesses and providers.
Conduct monthly field outreach targeting pharmacies and supermarkets.
Partner with Community Engagement to organize events within the sales territory (e.g., health fairs, parades, holiday-themed events, trade shows, hospital orientations, provider-sponsored events, and health-related theme events).
Establish and maintain relationships with local community organizations to promote Healthfirst benefits.
Assist DSE with follow-up visits with providers to ensure plan visibility and generate leads.
Provide DSE feedback and follow up on provider-related issues and solutions.
Assist DSE in conducting Provider portal orientation for new providers; educate practices on how to navigate the provider portal (member eligibility, authorization, claim lookup, membership roster, quality reports) to strengthen provider relationships and support quality score improvement.
Provide leads to DSE on new provider recruitment to diversify the network (FQHC, dental, pharmacy, hospital, IPA, community providers).
Advance Healthfirst through superior customer service in the assigned territory to optimize provider and member satisfaction.
Raise issues or concerns to management related to site coverage, competition, training needs, and propose process improvements to enhance workflows.
Minimum Qualifications

A Valid Driver’s License
High School Diploma or GED
New York State Life Accident (optional) & Health License (Mandatory)
Experience in one of the following: sales, marketing, provider relations
3 years of sales experience (1 year in health insurance industry)
Knowledgeable about and experienced with provider networks/hospitals
Bilingual
Excellent communication & interpersonal skills (oral & written)
Good computer skills & tech savvy (Microsoft Office)
Preferred Qualifications

Bachelor’s Degree from an accredited institution
Account management experience
Medicaid and/or Medicare managed care experience
Hiring Range

Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620
All Other Locations (within approved locations): $61,300 - $91,120
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 401(k) contributions. Healthfirst believes in providing a competitive compensation and benefits package where 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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