Healthcare Enrollment Specialist

Consent to Communication and Use of AI Technology: By submitting your application for this position and providing your email address(es) and/or phone number(s), you consent to receive text (SMS), email, and/or voice communication whether automated (including auto telephone dialing systems or automatic text messaging systems), pre-recorded, AI-assisted, or individually initiated from Aditi Consulting, our agents, representatives, or affiliates at the phone number and/or email address you have provided. The Health Insurance Enrollment and Outreach Representative educates and assists individuals and families with the enrollment and recertification process for on- and off-marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP), and Qualified Health Plans (QHP).

Payrate: $21.00 - $21.00/hr.

Summary
The Health Insurance Enrollment and Outreach Representative educates and assists individuals and families with the enrollment and recertification process for on- and off-marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP), and Qualified Health Plans (QHP). This role combines customer assistance and community outreach responsibilities to increase awareness of available healthcare coverage options, support member retention, and promote growth within an assigned territory. The position requires strong communication, customer service, organizational, and relationship-building skills, as well as the ability to apply marketplace regulations and enrollment requirements.

Responsibilities

• Establish and maintain trusted relationships with community influencers, local agencies, community-based organizations, and event participants within the assigned territory.
• Participate in community events, health fairs, outreach programs, and educational initiatives to increase awareness of available healthcare coverage options.
• Proactively engage local businesses and community groups to educate them about healthcare offerings, applicable regulations, and Company programs and services.
• Participate in departmental strategy discussions and provide customer feedback and competitive market insights.
• Collect and review household and income information to determine eligibility for healthcare coverage programs and financial assistance programs.
• Assist applicants in obtaining and submitting required documentation related to age, residency, income, and eligibility requirements.
• Explain available health insurance products, benefits, costs, and coverage options based on individual and family circumstances.
• Support member retention through effective onboarding and customer assistance practices.
• Serve as an advocate for applicants throughout the enrollment process and communicate application status and requirements to all involved parties.
• Apply marketplace rules, regulations, and enrollment guidelines when assisting current and prospective members.
• Communicate application requirements and eligibility information in more than one language when applicable.
• Calculate and compare financial information required during the enrollment process, including review of tax return documentation and financial statements for self-employed individuals.
• Interpret and apply complex enrollment instructions and regulatory guidance.
• Assess and analyze applicant information to support accurate enrollment decisions for individuals and families.
• Present enrollment information, eligibility requirements, and product offerings to community audiences and organizations.
• Meet with applicants at designated locations that provide enrollment support resources.
• Attend annual enrollment-related events and training opportunities to remain informed of program updates and policy changes.
• Provide coverage and support for team members during absences, schedule changes, outreach events, and customer appointments.
• Facilitate weekly staff meetings on a rotating basis and follow established meeting best practices.
• Promote workplace safety and maintain an organized work environment.

Requirements
Education Requirements

• High School Diploma required.
• Associate’s Degree preferred.

Experience Requirements

• One to two years of experience in a Marketplace Facilitated Enroller (MFE), customer service, sales, or related role preferred.
• New York State Marketplace Facilitated Enroller (MFE) certification must be obtained within three months of hire.
• Ability to work independently with minimal supervision.
• Strong attention to detail and organizational skills.
• Thorough understanding of Child Health Plus, Essential Plan, Medicaid/Medicaid Managed Care, and Qualified Health Plan products.
• Ability to evaluate customer needs and conduct research to resolve issues effectively.
• Ability to identify enrollment barriers and collaborate with applicants and marketplace representatives to resolve concerns.
• Experience presenting information to community organizations and public audiences.
• Commitment to ongoing professional development through meetings, workshops, seminars, and independent study.
• Ability to travel as required.
• Ability to handle confidential and sensitive information with discretion.
• Demonstrated ability to work effectively with culturally diverse populations.
• Demonstrated sensitivity when collecting personal and confidential information, including income, household composition, and immigration-related information.
• Basic mathematical proficiency, including addition, subtraction, multiplication, division, rounding, and unit-of-measure calculations.

Required Skills

• Customer service and member support
• Community outreach and relationship management
• Enrollment and eligibility assistance
• Health insurance product knowledge
• Public speaking and presentation skills
• Written and verbal communication skills
• Organizational and time management skills
• Analytical and problem-solving abilities
• Financial document review and interpretation
• Microsoft Office applications, including Word, Excel, and Access
• Email and calendar applications
• Customer relationship management (CRM) tools
• Ability to interpret policies, procedures, and regulatory guidelines
• Confidential information management

Preferred Skills

• Bilingual communication skills
• Experience working with community organizations and outreach programs
• Experience supporting health insurance enrollment programs
• Knowledge of healthcare marketplace regulations and enrollment processes

Pay Transparency: The typical base pay for this role across the U.S. is: $21.00 - $21.00 /hr. Non-exempt positions are eligible for overtime at a rate of 1.5 times the base hourly rate for all hours worked in excess of 40 in a work week, or as required by state or local law. Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education and experience. Full-time employees are eligible to select from different benefits packages. Packages may include medical, dental, and vision benefits, health savings accounts with qualified medical plan enrollment, 10 paid days off, 3 days paid bereavement leave, 401(k) plan participation with employer match,  life and disability insurance, commuter benefits, dependent care flexible spending account, accident insurance, critical illness insurance, hospital indemnity insurance, accommodations and reimbursement for work travel, and discretionary performance or recognition bonus. Sick leave and mobile phone reimbursement provided based on state or local law. 

Consent to Communication and Use of AI Technology: By submitting your application for this position and providing your email address(es) and/or phone number(s), you consent to receive text (SMS), email, and/or voice communication whether automated (including auto telephone dialing systems or automatic text messaging systems), pre-recorded, AI-assisted, or individually initiated from Aditi Consulting, our agents, representatives, or affiliates at the phone number and/or email address you have provided. These communications may include information about potential opportunities and information. Message and data rates may apply. Message frequency may vary.
You represent and warrant that the email address(es) and/or telephone number(s) you provided to us belong to you and that you are permitted to receive calls, text (SMS) messages, and/or emails at these contacts. You also acknowledge and agree to Aditi Consulting LLC’s use of AI technology during the sourcing process, including calls from an AI Voice Recruiter. AI is used solely to gather data and does not replace human-based decision-making in employment decisions. Calls may be recorded.

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