Community Connections Representative I​/II; Buffalo and Rochester

Community Connections Representative I/II (Buffalo and Rochester)

Join to apply for the Community Connections Representative I/II (Buffalo and Rochester) role at Excellus BCBS

This position assists the health plan in establishing a community presence through home visits and outreach, bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources, help navigate available resources, and provide assistance with addressing social‑determinants‑of‑health barriers and care gaps. They also educate and assist with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): on‑ and off‑marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market – Qualified Health Plan (QHP).

The role requires occasional evenings and weekends for outreach and community events, and the ability to drive independently within the health plan regions.

• Educates Medicaid, Medicare, and Commercial members on healthcare benefits and community resources through home visits and outreach.
• Assists members with accessing care, Case Management programs, benefits, and government cell‑phone programs.
• Coordinates, plans, and attends community events, including school events, health fairs, and various community initiatives; proactively informs and increases awareness of health‑care offerings, state regulations, and the Excellus/Univera brand/products within assigned territories.
• Completes scheduled and unscheduled home visits for non‑compliance, gaps in care, community resource needs, and other high‑risk issues.
• Conducts targeted phone calls for compliance, HEDIS initiatives, and health risk assessments.
• Collaborates with Case Management on the status of high‑risk member referrals.
• Assists in finding and connecting members to community social services and agencies; enrolls or refers qualified members to a health home.
• Communicates health‑insurance program options and fundamentals of all products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace.
• Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as required by the Marketplace.
• Interprets complex instructions from the MFE Training Manual to assist applicants; provides critical assessment and analysis affecting insurance enrollment for families and children; presents all aspects of eligibility, enrollment, and available products to community audiences.
• Meets with applicants in locations with additional MFE resource backup.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Manages incoming Community Connections referrals.
• Maintains the Community Resource Guide as needed.
• Ensures educational materials and supplies are replenished and available for use.
• Maintains the in‑house food pantry, ensuring all non‑perishable items are within use‑by date.
• Works with management to participate in training processes for new hires and team refreshers; supervises interns and/or mentors new hires, providing first‑level problem resolution and sharing Lifetime Way cultural expectations to ensure successful onboarding and engagement.
• Works with management to establish influential relationships in the community within assigned territory.
• Attends community IPA/Navigator agency as instructed.
• Represents the company in small and large community‑based organization meetings as required or in collaboration with the Community Engagement Program Manager.
• Gains subject‑matter‑expertise (SME) level in key focus area; develops training curriculum and…