Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege.

About NYC Health Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics.

For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Sales Representative is responsible for educating and assisting qualified individuals with purchasing affordable health insurance coverage and / or obtaining an eligibility determination for coverage in Qualified Health Plans (QHPs) and insurance affordability programs such as Medicaid and Child Health Plus (CHP) through the NY State of Health (MarketPlace).

The Sales Representative is responsible for identifying and educating prospective members that do not have health insurance and / or are looking to change coverage as well as assisting existing members with recertification and education of benefits.

The Sales Representative is tasked with performing all duties in accordance with the Affordable Care Act (ACA) as well as all other pertinent rules and regulations.

Job Description

Educational / Enrollment Process

Educate and provide assistance to qualified individuals with 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 the 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 from 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 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 the Marketplace functionalities to effectively manage individual accounts.

Conduct a daily review of the MetroPlus 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 MetroPlus portal at the time of the initial enrollment encounter.

All other tasks and responsibilities as may be required to satisfy the expectations of the role.

Minimum Qualifications

Must have a High School Diploma or GED.

Minimum of one (1) year of Sales / Customer Relations experience required.

Must be in compliance with all conflict-of-interest standards and regulations.

Required to work evenings and weekends.

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 a MFE

Professional Competencies

Integrity and Trust

Customer Focus

Functional / Technical Skills

Written / Oral Communications

Last updated : 2024-07-02