Bilingual Connecticut Medicaid & ACA Coverage Advisor

Bilingual Connecticut Medicaid & ACA Coverage Advisor

Internal Role Description & Hiring Alignment

Patient Operations & Coverage Distribution | Pointcare | September 2026

Title: Bilingual Connecticut Medicaid & ACA Coverage Advisor

Employment Type: Full-time hourly, 40 hours/week, non-exempt

Location: Remote- Connecticut

Compensation: $28/hour+ ACA Enrollment Incentive + Benefits

1. Role Summary

Pointcare is building a licensed coverage distribution function connected to its existing patient base, clinic relationships, app workflows, service introductions, and coverage-support operations. The Connecticut Coverage Advisor is a hybrid producer/support role responsible for helping Connecticut patients navigate Medicaid/HUSKY coverage issues and complete compliant ACA Marketplace enrollments through Access Health CT when a valid Marketplace pathway is independently established.

Connecticut is the primary market. As volume and readiness allow, the advisor may also support additional State-Based Marketplace states after all required licenses, certifications, appointments, and system access are complete. This is not a traditional cold-lead sales-floor role; Pointcare provides the patient opportunities, and the advisor owns both the coverage conversation and required follow-through.

2. Operating Model

Area Working Assumption

Coverage Distribution Manager

Connecticut Medicaid/HUSKY support, Access Health CT ACA enrollment, coverage-transition follow-up, and approved additional SBE support

Connecticut; additional State-Based Marketplace states may be assigned based on demand and readiness

Service-led coverage support using Pointcare patient relationships; no requirement to generate or purchase personal leads

Regular full-time W-2 non-exempt employee of Pointcare Inc.; remote from Connecticut

$28/hour + $15 per eligible, compliant ACA enrollment; no per-case Medicaid/HUSKY incentive

Pointcare full-time employee benefits, including 100% employer-paid employee-only medical, dental, and vision coverage and 401(k) eligibility, subject to plan terms

Full-time; primarily Eastern Time patient coverage with seasonal flexibility based on workload

3. Patient Base and Connecticut Coverage Model

●  Patients may enter through Medicaid renewal/lapse/denial workflows, coverage-loss transitions, app opt-ins, inbound coverage questions, clinic relationships, service introductions, or other valid coverage-support pathways.

●  The advisor supports approved Connecticut Medicaid/HUSKY workflows but does not use the ACA incentive to influence whether a patient remains in or leaves Medicaid.

●  ACA enrollment is appropriate only when a valid Marketplace pathway is independently established, such as a direct ACA opt-in, confirmed Medicaid loss/denial, or another independently validated eligibility pathway.

●  If the advisor materially participates in deciding or influencing the Medicaid pathway, the resulting ACA enrollment requires independent review before it can be treated as incentive-eligible.

●  Connecticut is the core assignment. Additional State-Based Marketplace work may be added only after the advisor is properly licensed, certified, appointed, and authorized for that state.

4. Core Scope of Work

5. Boundaries

6. Licensing, Certification and Readiness Requirements

7. Candidate Profile

Required

●  Active Connecticut resident health insurance producer license.

●  Bilingual communication capability; Spanish/English strongly preferred.

●  Hands-on ACA Marketplace enrollment experience and practical familiarity with Connecticut Medicaid/HUSKY coverage workflows.

●  Access Health CT broker/enrollment experience.

●  Ability to be aligned under Pointcare without a required release, hierarchy transfer wait, or similar contracting delay.

●  Strong understanding of consent, disclosures, documentation, patient education, complaint escalation, and compliant enrollment practices.

●  Reliable callback, document-chasing, and follow-up habits; comfortable owning work after the initial conversation.

●  Ability to work full-time remotely and manage state portals, enrollment systems, carrier portals, and assigned patient queues.

Strongly Preferred

●  Current 2027 Access Health CT broker certification and active Connecticut carrier appointments.

●  Existing nonresident licenses/certifications in other State-Based Marketplace states.

●  PY2026 FFM Marketplace registration/Exchange agreement, allowing future federal-platform support if PY2027 registration is completed.

●  Experience with Five9, EDE/enrollment platforms, carrier portals, or similar remote coverage tools.

8. Compensation and Incentive

Documentation, service, Medicaid/HUSKY support, application follow-up, effectuation, and retention remain core job expectations and performance metrics even when no enrollment incentive is earned.

9. First 90 Days

10. Pre-Start / Final Offer Requirements

●  Confirm Connecticut residency, resident producer license, language capability, Access Health CT experience, and current certification/appointment status.

●  Confirm the candidate can affiliate with Pointcare without a required release or waiting period that would delay launch.

●  Verify any PY2026 FFM status only if the role will include federal-platform states; do not treat FFM registration as a CT-only requirement.

●  Confirm assigned state footprint and calculate Pointcare-paid nonresident licensing/certification costs before filing.

●  Complete background checks, required licenses/certifications/appointments, systems access, and ready-to-sell validation before live enrollment.

●  Provide final written incentive plan and full-time benefit terms with offer/onboarding materials.