Licensed Health Insurance Agent

Description

This position will start by focusing on DSNIP and then switch over to Individual Plan during open enrollment season later in the year (October
1) DSNIP stands for Dual Eligible Special Needs Plan. It is a type of Medicare Advantage plan specifically designed for individuals who are "dual eligible", meaning they qualify for both:
Medicare (typically for people aged 65+ or with certain disabilities), and Medicaid (based on income and other state-specific criteria). Sentara Health offers a Dual Eligible Special Needs Plan (DSNP) called Sentara Community Complete (HMO D-SNP), designed for individuals who qualify for both Medicare and Medicaid. Sentara Health's DSNP strategy is centered around the "Exclusively Aligned Enrollment" model, which became mandatory in Virginia starting January 1, 2025.

This model requires that members who are dual-eligible must receive both their Medicare and Medicaid benefits from the same health plan. Sentara is looking to get DSNIP Alignment of 11,000 Medicaid Members The government recently updated regulations to say that whatever plan a member has for Medicare, they have to use the same insurance company for their Medicaid. Sentara is the biggest Medicaid provider in Virginia and they do not want to lose any more members as they have already lost a lot of funding from the government.

Any Dual Members can make changes to their policy once per month so this is a constant project and a huge push for Sentara right now. They have 10 different mailing campaigns going out between end of May - end of December so are expecting a lot of call volume from this. Our team will be focused on DSNP for a majority of the time between their start to AEP which is October 1- then their focus will shift to Individual Plan The volume will be very high but when inbound calls are not coming in - they will be handling outbound projects.

Some examples of outbound projects
- Care coordinators (medicaid side of business) send referrals - these people can be aligned to DSNP - the team will call CSNP retention efforts - need to show proof of chronic illness and certain medical documents to stay enrolled IFP
- Kids aging off their parents plan over 26- calling them to get enrolled in a plan Expectation
- Minimum conversion of calls to sales- 6% 10 enrollments per week is a good number to shoot for POSITION DUTIES AND PRIMARY RESPONSIBILITIES The Licensed Telesales Representative is responsible for educating beneficiaries about products, on their healthcare options and helping them make an informed decision on which plan is most appropriate for their individual health needs. Responsible for selling Dual Eligible Special Needs Plan (D-SNP) to eligible beneficiaries telephonically.

This includes strict adherence to the Centers for Medicare and Medicaid Services (CMS) Sales and Marketing regulations and Sentara Health Plan policies and procedures. Only able to sell Sentara Health Plan products. Maintain yearly appropriate training and licensure renewal as required. Must have Virginia insurance license, have or be eligible for AHIP certification, Medicare and/or Contact Center experience. The typical day will be taking incoming calls from potential members who are looking to see if they qualify to enroll for coverage.

Based on information that the prospective member provides the Insurance Agent will be evaluating to see if they qualify for an Individual or DSNIP Plan. The agent will also be responsible for providing insurance coverage quotes and educating the prospective member on plan inclusions and offerings. They will also be responsible for completing the enrollment if the caller would like to move forward with the plan.

If the caller is not eligible they are letting them know who they can call for more information. In addition will responsible for transferring calls from those who call into the wrong department. If there is downtime there would be outbound calls to families who's dependents are aging off of plan and offering individual quotes to those. This will be both inbound and outbound calls

Skills

Licensed Insurance Agent, Health Insurance, Medicare, Medicaid, DSNIP, CMS,…