Navicare Administrative Operations Coordinator - WFH

Worcester, MA, USA|

Job Overview

Compensation

Salary

Range $65,000.00 - $72,000.00

Benefits

Health Insurance

Dental Insurance

Paid Time Off

Retirement Plan

Professional Development

Employee assistance program

Disability insurance

Job Description

Fallon Health is a reputable and member-focused health insurance company established in 1977 in Worcester, Massachusetts. Known for prioritizing its members, Fallon Health is dedicated to providing equitable, high-quality, and coordinated care. The company continually ranks among the nation’s top health plans for member experience, service, and clinical quality. It specializes in government-sponsored health insurance programs, including Medicare, Medicaid, and PACE, aiming to improve health outcomes and inspire hope within the communities it serves.

One of Fallon Health's key programs is NaviCare, designed specifically for individuals aged 65 and older who reside within the company's service area and hold MassHealth Standard, with or without Medicare coverage. NaviCare blends the benefits of MassHealth (Medicaid) and Medicare, including prescription drug coverage, to offer comprehensive health care support tailored for the elderly and disabled population. Fallon Health is committed to embracing diversity and inclusion, valuing the unique characteristics and backgrounds of its members and employees, ranging from age, race, ethnicity, gender identity, physical and mental ability, to socioeconomic status.

The Navicare Outreach Operations Coordinator role is critical to the ongoing success and growth of the NaviCare program. This full-time position offers an annual salary range of $65,000 to $72,000, based on experience and fit. The Coordinator is responsible for maximizing the productivity of the Navicare Outreach team by delivering robust sales and marketing support aimed at both expanding and retaining the NaviCare member base. This position requires expertise in presenting, promoting, and marketing health insurance programs to a variety of audiences including individuals, groups, healthcare professionals, and community organizations.

Key responsibilities include coordinating retention activities and acting as a liaison across departments like Clinical, Provider Relations, and Network Development Management to address member issues and optimize sales opportunities. The Coordinator will skillfully develop and deliver presentations, assist in planning educational and outreach events, manage compliance with Medicare and Medicaid marketing policies, and continuously recommend improvements to enhance service delivery.

Additionally, the role involves managing schedules and documentation within CRM and CMS systems, producing reports for management, supporting sales representatives at offsite events, and ensuring clear communication with prospects using a personal and professional touch. The Coordinator must stay informed about healthcare industry trends and competitor offerings, providing insights that help keep Fallon Health competitive and member-focused. A strong collaborator and self-starter, this person must balance independent work with teamwork, prioritize effectively, and be culturally sensitive when performing community outreach.

Overall, this opportunity at Fallon Health offers a rewarding career path for those passionate about healthcare marketing and community engagement, especially focused on supporting older adults through innovative health plans. It is a position that blends strategic thinking, operational excellence, and a genuine commitment to improving members' lives through direct community impact and cross-departmental collaboration.

Job Requirements

Associate's degree or equivalent
minimum 2 years experience in related field
English proficiency
driver's license
AHIP certification
satisfactory criminal background check (CORI)
ability to pass annual product certification exam
knowledge of Medicare & Medicaid programs
experience in sales, marketing or customer service
experience working with elderly or disabled populations
familiarity with healthcare systems and community resources
self-motivation and accountability
strong interpersonal and presentation skills
capability to meet clients in various settings
ability to perform outreach in diverse communities
organizational skills
teamwork and independent work capabilities
proficiency with Microsoft Excel and Word
ability to manage multiple tasks
independent learning skills
strong customer service orientation
effective problem-solving abilities
meticulous attention to detail
ability to train and mentor others

Job Qualifications

Associate's degree or equivalent
2 years related experience
English required
proficiency in Portuguese and Spanish preferred
current driver's license
AHIP certificate
satisfactory CORI results
annual completion of product certification exam
annual AHIP certification
thorough knowledge of Medicare and Medicaid services, marketing, enrollment policies and guidelines
experience in sales, marketing and customer service preferred
experience working with elders and disabled individuals
knowledge of healthcare systems, community organizations, social services and public resources
self-starter
high level of accountability and responsibility
exceptional interpersonal and presentation skills
ability to meet with members, responsible parties or providers in office or home settings
ability to work in a multicultural environment and perform outreach
ability to work independently and within a team
highly organized and able to prioritize
proficient with Excel, Word, Fallon CRM and QNXT
ability to prepare and manipulate spreadsheets
ability to handle multiple priorities
independent learning skills
exceptional customer service and collaboration skills
critical thinking and problem-solving skills
attention to detail and accuracy
ability to mentor and train others

Job Duties

Develop presentations independently and in collaboration with Communications and Compliance
Facilitate presentations to various target audiences including prospects, community referral sources and others
Attend and assist with the planning of educational, outreach and other health related events
Coordinate and interact with various roles within and its primary care partners to ensure customer requests, questions and issues are handled appropriately and in a timely manner
Assure compliance and adherence with Medicare & Medicaid enrollment and marketing policies and procedures
Offer recommendations and suggestions for improvements in office, enrollments, marketing practices etc. to enhance service delivery and customer satisfaction
Work closely with Account Executives to create an event schedule for all Navicare sales activities
Maintain event calendar and ensure accuracy and documentation into the CRM
Maintain the CMS event log
Produce various reports for Management
Field inbound calls for the Navicare product
Maintain working knowledge of competitor benefit information, health care industry trends, and health care reform activities
Generate written correspondence and sales packets for prospects as requested
Maintain a personal touch in all correspondence and communication with prospects
Support outside sales representatives at offsite events including presentations, staffing health fairs and one on one visits
Support the Sales Executives with any administrative requests that helps support our Membership goals
Responsible for the preparation/compilation of reports related to the departments key objectives
Create internal procedure documents for all operational tasks
Become an expert on internal sales systems such as Sharepoint and CRM
Create ROI reports on all marketing campaigns for Navicare
Generate and analyze reports from various contracted partners to ensure Navicare effective penetration of each market