About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s NaviCare is a program for people age 65 and older, who live in our service area, and who have MassHealth Standard, and may have Medicare. It combines MassHealth (Medicaid) and Medicare benefits, including prescription drug coverage. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique. 

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region.

Brief summary of purpose:

This position requires that the Account executive achieves personal referral and outreach goals for and the NaviCare program. Manages a territory and group of referral source accounts, providing regular follow up and overcoming barriers with each account to meet enrollment goals. 

Primary Job Responsibilities:

1.Relationship Building

• Creates productive and collaborative relationships with internal and external referral sources in order to obtain qualified referrals and enrollments for the NaviCare program.
• Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events to ensure Fallon Health’s visibility and presence in your territory.
• Presents the NaviCare program to groups who are likely prospects, caregivers and community referral sources.
• Develops and implements their own territory business development plan and carries out activities to penetrate accounts listed on the plan.

2.Lead Generation

• Works collaboratively with Navicare enrollment team to discuss progress of referrals and ideas for resolving issues.
• Provides inservice orientations to vendors and providers on an annual basis.
• Shows accountability and follows up with prospects until the lead is closed/withdrawn and document as appropriate. Achieves monthly referral and home visit request goals

3.Secure Applications

• Generates sufficient NaviCare enrollment applications to meet monthly enrollment goals.
• Explains the NaviCare program clearly and consistently to prospects and their families to ensure that prospects enroll with a solid understanding of the program maintaining a low disenrollment rate. Meets with NaviCare prospects in their homes.
• Completes application and other documentation needed.
• Submits all completed applications in a timely manner as required by CMS.

4.Tracking & Reporting

• Documents all sales activities in the department’s CRM application and account management grid in a timely manner.
• Meets weekly sales activity deliverables consistently, and tracks these in the CRM and their Outlook calendar.
• Maintains records of NaviCare applications and documentation related to scope of appointments.

5.Assessment

• Regularly reviews effectiveness of efforts against goals.  Provides market intelligence to the NaviCare/ Manager and the Outreach Director so that adjustments can be made to tactical plans.
• Manages their own professional development by seeking advice, training, and coaching from their colleagues, manager, and the Director of Outreach.

6.Regulatory Guidelines

• Operates within the marketing and outreach guidelines and regulations provided by CMS and EOHHS.
• Retains Scope of Appointment and other Enrollment Records.
• Submits information on NaviCare prospect events to Outreach Support in a timely manner, for CMS submission.
• When in doubt, asks questions pertaining to compliance or privacy regulations.

Education, 

• BS or BA degree and/or comparable experience

Certification and Licenses:

• License: Massachusetts Driver’s License
• Certification: AHIP

Experience:

• Knowledge and experience working with community organizations,  low income communities and the elderly
• 3 years of sales experience in healthcare or group insurance strongly preferred.
• Must have proven experience working in a customer facing role focused on sales, lead generation in a high paced customer service or sales environment.
• Knowledge of Medicare, Medicaid and insurance products is desirable. 
• Knowledge of customer service, sales, outreach and marketing principles and practices.
• Possession of a valid Mass. driver’s license and a vehicle to be used for marketing activities and home visits. 

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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