Benefit Advocacy Specialist

Position Summary The Benefit & Advocacy Specialist (BAS) is responsible for enrolling HIPP‑eligible Medicaid patients and qualified family members into employer‑sponsored health insurance plans. This role requires direct engagement with employers, policyholders, third‑party administrators, benefit portals, and occasionally insurance brokers. Success requires resilience, attention to detail, strong communication skills, and the ability to navigate complex insurance structures and employment regulations with confidence. The BAS plays a critical role in ensuring patients maintain coverage while protecting reimbursement integrity and compliance standards. Key Responsibilities Employer Enrollment & Advocacy Communicate with employers via phone, email, and text to coordinate enrollments Review and evaluate benefit plans, rate sheets, and summaries of benefits Navigate complex employment laws, COBRA regulations, and state subsidy programs Assist with online and phone‑based benefit enrollments Calculate and resolve retroactive premiums and enrollment challenges Obtain temporary IDs and expedite verification processes when needed Ensure enrollment data and documentation are complete, accurate, and ready for state application submission Advocate proactively to ensure employee and patient rights are respected Patient & Family Support Assist employees and family members in understanding benefit materials and enrollment requirements Review paystubs to confirm accurate deductions and reimbursement alignment Educate employees on plan options, timelines, and qualifying life events Empower families by simplifying complex insurance concepts Problem Solving & Case Resolution Resolve enrollment‑related issues, including qualifying life events (QLEs) and retroactive effective dates Partner with Patient Helpers, Regional VPs, and State Operations teams to ensure continuity of coverage Address employer, broker, or employee inquiries with professionalism and urgency Maintain case momentum and prevent administrative delays Collaboration & Continuous Improvement Participate in weekly case review calls Collaborate cross‑functionally to ensure consistent execution and documentation standards Contribute to process improvements as PFA scales Perform additional duties as assigned What Success Looks Like in This Role Enrollments are accurate, timely, and compliant Cases move forward without unnecessary delays Employers experience PFA as professional, knowledgeable, and solutions‑oriented Patients and families feel informed, supported, and empowered Documentation supports reimbursement recovery and audit readiness Qualifications Required Qualifications Strong written and verbal communication skills Demonstrated problem‑solving and conflict resolution abilities Ability to explain complex insurance and employment concepts in clear, simple terms Excellent organizational skills and attention to detail Strong time management and ability to manage multiple active cases Ability to work independently while collaborating effectively across teams Comfort navigating technology, benefit portals, and documentation systems Ability to thrive in a fast‑paced, high‑growth organization Preferred Background in insurance, employee benefits, healthcare enrollment, or advocacy Knowledge of employer‑sponsored health plans, COBRA, ACA, or related employment law Experience working with Medicaid or premium assistance programs Full bilingual proficiency in Spanish is preferred Our Benefits – Supporting You Inside and Out At Patient Funding Alternatives, we know that caring for others starts with caring for our own people. That’s why we offer a comprehensive, industry‑leading benefits package designed to support your health, your future, and your wellbeing. Our team members enjoy medical, dental, and vision coverage through UnitedHealthcare and Guardian, employer‑paid life and disability insurance, and a 401(k) plan with company match. We also invest in your wellness — with up to $100 annual reimbursement for fitness, mindfulness, and wellness activities, plus access to mental health tools like the Calm Health app and a 24/7 Employee Assistance Program. From flexible spending accounts to nationwide fitness programs and virtual care, PFA is committed to helping you stay healthy, balanced, and thriving — at work and beyond. Compensation $65,000-$65,000 per year #J-18808-Ljbffr