State Programs Facilitated Enroller

Excellus Health Plan Inc.; City of Albany (NY); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Excellus Health Plan Inc. is seeking a State Programs Facilitated Enroller to assist individuals with NY State of Health enrollments and renewals, reviewing income documents and eligibility in NYSOH and EMEDNY systems.

The role emphasizes outbound calls, inquiries handling, and timely data entry in Salesforce. You will support community outreach events and maintain confidentiality while delivering accurate information about plans, provider networks, and prescription programs.

Qualifications

• High school diploma or GED required.
• Certification as Marketplace Facilitated Enroller or CAC required or must be obtained within 30 days of hire.
• Minimum of 1 year employment experience in a health insurance setting required, with experience in Government Programs preferred.
• Demonstrated ability to interpret and make decisions based on underwriting guidelines and NYS/Federal healthcare statutes.
• Demonstrated ability to identify problems and implement effective solutions.
• Demonstrated ability to maintain confidentiality and provide excellent customer service.
• Excellent verbal and written communication skills; bilingual abilities are a plus.

Responsibilities

• Assist members with renewals and new applications by phone.
• Serve as primary contact for enrollment inquiries via phone, email, or other written correspondence.
• Enter enrollment information into Salesforce in a timely manner and maintain accurate notes.
• Provide information about plans, provider networks, and prescription programs.
• Support outreach and scheduling enrollment appointments as needed.
• Ensure compliance with NYS and federal regulations and internal policies.

Skills

Customer service

Enrollment experience

Spanish or other language

Communication skills

Data entry

Education

High school diploma or GED

CAC/CAC certification (Marketplace Facilitated Enroller)

Tools

Salesforce

Facets

EMEDNY

InContact

NY State of Health system

Job description

Job Description:

Summary:

The State Programs Facilitated Enroller is responsible for assisting individuals with enrollment and renewal applications through the NY State of Health marketplace system. This includes reviewing taxes, payroll stubs, and other income documents and reviewing eligibility within the NY State of Health and EMEDNY systems according to NYS Department of Health (NYSDOH) guidelines. The State Programs Facilitated Enroller duties will also include conducting outreach and enrollment calls, working directly with customers over the phone to assist them with renewing their applications or completing new applications as permitted by the state, assisting with the NY State of Health inquiry process, answering questions regarding specific CDPHP plans offered through NY State of Health, processing member recertification applications, adds, changes and terminations. The candidate will also handle renewals over the phone, and as needed, community outreach events, or other questions related to enrollment. All Facilitated Enrollers must conduct themselves in accordance with regulations and instruction set forth by NYS and the Federal government and are expected to meet all defined CDPHP standards of outreach.

Essential Accountabilities:

• As a State Programs Facilitated Enroller, the primary responsibility is assisting members in renewing coverage through the NY State Health, including any inquiries in that process, with recertification applications, assisting with changes to their application, and providing general information about the program over the phone.
• Point of contact for the resolution of all inquiries received via phone calls, emails, or other written correspondence regarding enrollment in the NY State of Health. This includes, but is not limited to, making outbound calls to investigate or retrieve missing or incomplete information. Act as principal interface with the customer on the telephone for enrollment and renewals in State Programs. Effectively deliver enrollment verification information via approved scripting, including, but not limited to discussing the use of the plan identification card, provider network, and prescription program, if applicable.
• Assist prospective members with inquiries on and enrolling into individual off-exchange health plans directly with CDPHP.
• Maintain appropriate standards of outreach to new and existing members to contribute to the growth of membership.
• Work with and have a comprehensive understanding of Facets, EMEDNY, InContact, Macess EXP, and NY State of Health database and all other vendor and in house systems used to perform departmental tasks.
• Enter enrollment information into Salesforce in a timely manner and maintain accurate notes within Salesforce on the enrollment activity of the customer.
• Perform all duties and assignments in compliance with corporate and department performance standards and agreements.
• Work closely with all team members to ensure the team meets all established goals for accuracy, timeliness, and customer satisfaction.
• Assist with inbound calls and scheduling enrollment appointments as needed.
• Ensure confidentiality of all data in compliance with department and Plan confidentially policies.
• Communicate the goals and processes of State Programs effectively and efficiently both internally and externally.
• The employee agrees to comply with CDPHP's Corporate Compliance Policy, and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer.
• Performs other duties as assigned.
• Be available for after-hours events as needed.

Minimum Qualifications:

• High school diploma or GED required.
• Marketplace Facilitated Enroller certification or Certified Application Counselor certification required or must be obtained within 30 days of hire.
• Minimum of 1 year employment experience in a health insurance setting required, with experience in Government Programs preferred.
• Demonstrated ability to interpret and make decisions based on corporate underwriting guidelines, as well as State of New York & Federal statutes relating to healthcare administration.
• Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.
• Demonstrated ability to work with and maintain confidential information.
• Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
• Excellent verbal and written communication skills.
• Flexibility to adapt to a changing and fast-paced environment.
• Strong system research and analysis skills; deductive and creative thinking.
• Strong attention to detail and capability to meet established productivity and quality standards.
• Demonstrated ability to effectively manage time with multiple task assignments.
• Ability to speak Spanish or another language preferable.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

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.

Compensation Range(s):

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 opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.