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 |
|---|
Reports to | Coverage Distribution Manager |
Primary scope | Connecticut Medicaid/HUSKY support, Access Health CT ACA enrollment, coverage-transition follow-up, and approved additional SBE support |
Primary market | Connecticut; additional State-Based Marketplace states may be assigned based on demand and readiness |
Patient model | Service-led coverage support using Pointcare patient relationships; no requirement to generate or purchase personal leads |
Employment | Regular full-time W-2 non-exempt employee of Pointcare Inc.; remote from Connecticut |
Compensation | $28/hour + $15 per eligible, compliant ACA enrollment; no per-case Medicaid/HUSKY incentive |
Benefits | Pointcare full-time employee benefits, including 100% employer-paid employee-only medical, dental, and vision coverage and 401(k) eligibility, subject to plan terms |
Schedule | 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
Pillar | What the Advisor Owns |
|---|
Medicaid/HUSKY support | Support approved renewal, redetermination, coverage-loss/denial, document, portal-navigation, and member-assisted workflows; explain next steps and route cases appropriately. |
Coverage transitions | Identify independently established loss-of-coverage or other valid transition pathways and route the patient to the appropriate coverage workflow. |
Access Health CT enrollment | Within active broker certification/appointments, educate on available Marketplace options, complete plan comparison, and support accurate ACA enrollment through approved systems. |
Application follow-up | Track pending applications, verification requests, missing information, carrier/Marketplace issues, and assigned callbacks through resolution. |
Effectuation, retention and service | Support first-payment/effectuation questions where applicable, post-enrollment questions, retention/service, and coverage continuity. |
Additional SBE support | Support other assigned State-Based Marketplace states only within active licenses, certifications, appointments, and Pointcare-approved workflows. |
Documentation and QA | Maintain complete notes, dispositions, consent/disclosure records, enrollment documentation, and participate in call monitoring, QA, and coaching. |
5. Boundaries
Owns | Does Not Own |
|---|
Connecticut Medicaid/HUSKY support and Access Health CT enrollment within approved workflows | Steering a patient away from Medicaid/HUSKY to create an ACA enrollment or incentive opportunity |
Patient education, document follow-up, callbacks, and coverage-transition support | Making unsupported Medicaid eligibility determinations or providing legal advice |
ACA plan comparison and enrollment when a valid Marketplace pathway is independently established | FFM/SBE-FP enrollment unless the advisor separately satisfies federal-platform registration requirements |
Escalating eligibility, complaint, compliance, or workflow concerns to the appropriate lead/manager | Unapproved outbound marketing, scripts, contact methods, carriers, products, or work outside active license/certification/appointment scope |
6. Licensing, Certification and Readiness Requirements
Requirement | Working Expectation |
|---|
Resident license | Active Connecticut resident health insurance producer license at hire. |
Language | Bilingual capability required; Spanish/English strongly preferred. |
Connecticut Marketplace | Practical Access Health CT broker/enrollment experience required. Current 2027 AHCT certification strongly preferred; certification and required appointments must be complete before live ACA enrollment. |
Hierarchy / release | Candidate must be able to affiliate and obtain required appointments under Pointcare without a release, transfer waiting period, or other hierarchy restriction that would delay launch. |
Federal-platform eligibility | Not required for CT-only/full-SBE work. Any FFM or SBE-FP assignment requires a PY2026 FFM Exchange agreement and completion of applicable PY2027 returning-agent registration before live enrollment. |
Nonresident / SBE readiness | Must be able to obtain Pointcare-required nonresident licenses and state Marketplace certifications for any additional assigned states; Pointcare pays approved role-required filings. |
Ready-to-sell status | No ACA enrollment until required license, certification, appointments, systems access, and Pointcare readiness checks are complete. |
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
Component | Planning Guidance |
|---|
Hourly base | $28/hour; regular full-time W-2 non-exempt. |
ACA enrollment incentive | $15 per eligible, approved/accepted, compliant ACA enrollment. |
Medicaid/HUSKY work | Hourly work only; no per-case Medicaid/HUSKY incentive. |
ACA incentive guardrail | Eligible only when ACA eligibility/pathway is independently established. If the advisor materially participates in deciding or influencing the Medicaid pathway, independent review is required before incentive eligibility. |
Payout trigger | Single payout at Marketplace/carrier acceptance after required documentation and QA are validated as complete and compliant. |
Chargebacks | No employee chargeback for later member cancellation, lapse, non-payment, or disenrollment when the original enrollment was valid and compliant. |
Ineligible incentives | Rejected, duplicate, invalid, unauthorized, non-compliant, or unverified-transition enrollments are not incentive-eligible. |
Overtime | Paid in accordance with applicable federal/state wage-and-hour requirements. |
Benefits | 100% employer-paid employee-only medical, dental, and vision coverage plus standard Pointcare full-time benefits, subject to plan terms. |
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
Phase | Expected Focus |
|---|
Days 1-30: Readiness and training | Confirm CT license/affiliation, complete AHCT and carrier readiness, learn Pointcare Medicaid/ACA workflows, scripts, consent/disclosures, systems, QA standards, and mock calls. |
Days 31-60: Controlled production | Begin live CT coverage work once authorized; balance Medicaid/HUSKY support with independently eligible ACA transitions, receive frequent coaching, and build consistent documentation/follow-up habits. |
Days 61-90: Production and optimization | Manage a full assigned CT workload, maintain QA/compliance standards, support additional SBE work if authorized, and provide feedback on routing, patient volume, state workflows, and recurring coverage barriers. |
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.
