Marketplace Facilitated Enroller

Job Description

The Marketplace Facilitated Enroller educates and assists individuals and families with the enrollment and recertification process for On and Off Marketplace health insurance products. This role combines hands-on enrollment support with outreach and business development activities aimed at increasing education, awareness, retention, and membership growth among small businesses, community agencies, and local organizations within an assigned territory.

Responsibilities

• Educate individuals, families, and community members on the full portfolio of health insurance products, including Child Health Plus, Essential Plan, Medicaid/Medicaid Managed Care, and Qualified Health Plans, as well as associated benefits and costs.
• Assist applicants with the enrollment and recertification process for On and Off Marketplace health insurance products, ensuring accurate completion of applications and required documentation.
• Collect and review family income and household information to help determine eligibility for health insurance programs, including Adjusted Premium Tax Credits and Cost Sharing for individuals and families.
• Support applicants in securing and providing documentation needed to verify age, residency, and income as required by the Marketplace.
• Communicate health insurance program options and fundamentals in a clear, understandable manner based on analysis of each applicant’s situation.
• Act as a member advocate to the Marketplace, applying Marketplace rules and regulations to individual situations and maintaining open communication on application status and requirements.
• Read, interpret, and apply the Marketplace Facilitated Enroller Training Manual rules and regulations when working with current or potential members.
• Communicate application and eligibility requirements in more than one language to better serve diverse community populations.
• Calculate and compare financial information required during enrollment, including recognizing and interpreting tax returns and three months of financial statements for self-employed applicants.
• Interpret complex instructions from the Marketplace Facilitated Enroller Training Manual to guide and assist applicants through the enrollment process.
• Provide critical assessment and analysis that impacts insurance enrollment decisions for families and children.
• Present eligibility criteria, enrollment processes, and available health insurance products to community audiences, including small businesses, local agencies, and grassroots organizations.
• Establish trusted relationships with community influencers, local agencies, and organizations through participation in health fairs, community events, and other outreach activities.
• Proactively reach out to local businesses within the assigned territory to educate them on health care offerings and state regulations, and to increase awareness of available health insurance options.
• Participate in department business strategy sessions and provide feedback from the customer’s perspective, including competitive intelligence gathered in the field.
• Improve customer retention through effective onboarding practices defined as part of the assister process, ensuring a smooth transition into coverage for new members.
• Meet with applicants at designated locations that provide additional Marketplace Facilitated Enroller resource backup to support complex cases and high-volume periods.
• Attend annual regional enrollment events to stay current on new information, regulatory changes, and product updates relevant to upcoming annual enrollment periods.
• Back up team members as needed, including coverage for vacations, last-minute appointment changes, and outreach events, to ensure continuous service to applicants and community partners.
• Maintain thorough, accurate data entry and documentation in client relationship management tools and other technical applications used to track enrollment activities and member interactions.
• Stay up to date on developments related to health insurance programs, marketplace regulations, and enrollment processes by attending meetings, seminars, workshops, and engaging in independent study.

Essential Skills

• High School Diploma and 1–2 years of experience, preferably in Marketplace Facilitated Enroller work, customer service, or sales.
• New York State Marketplace Facilitated Enroller (MFE) training and certification.
• New York State Life, Accident, and Health (LAH) license.
• Thorough knowledge of Child Health Plus, Essential Plan, Medicaid/Medicaid Managed Care, and Individual Market Qualified Health Plans.
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