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The ACA Marketplace Patient Coverage Advisor is responsible for educating patients on Marketplace options, managing compliant enrollments, and handling application follow-up and retention. The role involves maintaining accurate documentation, resolving verification issues, and providing ongoing service to patients within the western-region footprint.
ACA Marketplace Patient Coverage Advisor - West Coast
Internal Role Description & Hiring Alignment
Patient Operations & Coverage Distribution | Pointcare | September 2026
Pointcare is building a licensed ACA Marketplace distribution function connected to its existing patient base, clinic relationships, app workflows, service introductions, and coverage-support operations. The ACA Marketplace Patient Coverage Advisor is a hands-on producer responsible for helping eligible patients understand Marketplace options, complete compliant enrollments, and resolve the follow-through required after an application is submitted.
This role supports an assigned western-region footprint and scheduled Pacific Time patient coverage. It is not a traditional cold-lead sales-floor role. Pointcare provides patient opportunities, and the advisor owns enrollment, documentation, application follow-up, effectuation support, retention/service, and patient education.
Area | Working Assumption |
|---|---|
Reports to | Coverage Distribution Manager |
Primary scope | ACA Individual Marketplace education, compliant enrollment, application follow-up, effectuation/retention, and member service |
Regional assignment | Western-region priority states based on licensing, certification, carrier availability, and patient demand |
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 |
Compensation | $24/hour + $15 per approved/accepted, compliant ACA enrollment |
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; scheduled Pacific Time patient coverage with OEP/peak-season flexibility |
● Patients may enter through app opt-ins, Medicaid-loss transitions, age/coverage transitions, inbound coverage questions, clinic relationships, service introductions, outreach programs, or other valid Marketplace opportunities.
● The role is patient-first and compliance-led. Enrollment is appropriate only when the patient has a valid enrollment pathway, required consent/disclosures are complete, and the selected coverage is appropriate for the patient’s stated needs.
● OEP creates the broadest annual enrollment opportunity. Outside OEP, advisors primarily support patients with valid Special Enrollment Periods and ongoing post-enrollment service needs.
● The western-region footprint is a routing and licensing assignment, not a separate compensation band. State assignments may change as Pointcare adds licenses, certifications, carrier access, and patient volume.
● Pointcare provides the patient opportunities. Advisors are expected to own required service, callbacks, document chasing, and follow-up rather than operate as one-call closers.
Pillar | What the Advisor Owns |
|---|---|
Consent and intake | Follow required consent, disclosure, identity/eligibility, and documentation workflows before quoting or enrollment activity. |
Eligibility and education | Support OEP/SEP workflows within authorized scope; explain Marketplace options, costs, provider/prescription considerations, and enrollment next steps in clear language. |
Enrollment | Complete accurate ACA Marketplace applications and enrollments through approved federal/state Marketplace, EDE, carrier, or other authorized systems. |
Application follow-up | Track pending applications, verification requests, document needs, Marketplace/carrier 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. |
Regional coverage | Work assigned western-region 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. |
Owns | Does Not Own |
|---|---|
ACA education, plan comparison, enrollment, application follow-up, documentation, and service within assigned states | Working a state, Marketplace, carrier, or product before required license/certification/appointment/readiness is complete |
Valid OEP/SEP enrollment support and patient-appropriate plan comparison | Creating, coaching, or misrepresenting a qualifying life event or other eligibility fact |
Assigned callbacks, verification follow-up, effectuation support, and retention/service | Unapproved outbound marketing, scripts, contact methods, or enrollment tools |
Escalating compliance, complaint, consent, eligibility, or carrier issues to the appropriate lead/manager | Legal advice, final compliance interpretations, or steering based on advisor incentive, carrier preference, or enrollment volume |
Requirement | Working Expectation |
|---|---|
Resident license | Active health insurance producer license in resident state at hire. |
PY2026 FFM gate | Required for this launch role: candidate must have had a Plan Year 2026 FFM registration/Exchange agreement. Status must be verifiable by NPN. |
PY2027 FFM readiness | Must complete applicable Plan Year 2027 returning-agent registration, training, and agreements before live FFM/SBE-FP enrollment. |
Hierarchy / release | Candidate must not require a release, hierarchy transfer waiting period, or other approval from a current/former agency or upline that would delay Pointcare contracting or appointments. |
Nonresident / SBE readiness | Must be able to obtain required nonresident licenses and applicable State-Based Marketplace certifications for assigned states; Pointcare pays approved role-required filings. |
Carrier / agency alignment | Must be eligible for Pointcare-approved carrier/agency/upline relationships for the assigned footprint. |
Ready-to-sell status | No live enrollment until required licenses, FFM/SBE certifications, appointments, systems access, and Pointcare readiness checks are complete. |
● Active health insurance producer license in resident state.
● Plan Year 2026 FFM Marketplace registration/Exchange agreement and eligibility to complete PY2027 returning-agent registration.
● Practical ACA Individual Marketplace sales/enrollment experience.
● No required release, hierarchy transfer waiting period, or similar contracting restriction that would delay Pointcare alignment.
● Strong understanding of OEP/SEP eligibility, consent, disclosures, documentation, complaint escalation, and compliant enrollment practices.
● Strong phone communication and patient-education skills, with the ability to explain complex coverage in clear language.
● Reliable documentation, callback, document-chasing, and follow-up habits; comfortable owning work after application submission.
● Ability to work full-time remotely on a schedule aligned to Pacific Time patient coverage.
● Existing licenses across multiple western-region states.
● Current certifications for one or more western State-Based Marketplaces.
● Experience with HealthSherpa or other EDE platforms, Five9, carrier portals, and remote enrollment workflows.
● Experience supporting Medicaid-loss transitions, provider continuity, prescription continuity, and post-enrollment service questions.
● Bilingual Spanish/English or another language aligned with patient needs.
Component | Planning Guidance |
|---|---|
Hourly base | $24/hour; regular full-time W-2 non-exempt. |
Enrollment incentive | $15 per approved/accepted, compliant ACA enrollment. |
Payout trigger | Single payout at Marketplace/carrier acceptance after the enrollment and required documentation 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, or non-compliant applications are not incentive-eligible. |
Carrier neutrality | Advisor incentive does not vary by carrier or plan selected. |
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. |
Effectuation, retention, document completion, callbacks, and post-enrollment service remain core job expectations and performance metrics even though the enrollment incentive is paid at acceptance/approval.
Phase | Expected Focus |
|---|---|
Days 1-30: Readiness and training | Verify PY2026 FFM status, complete PY2027 registration and assigned-state licensing/certifications, learn Pointcare workflows/systems, review scripts/disclosures, complete mock calls, and calibrate to QA standards. |
Days 31-60: Controlled production | Begin live Marketplace calls once ready-to-sell; work assigned western-region opportunities, receive frequent coaching, and build consistent documentation/follow-up habits. |
Days 61-90: Production and optimization | Manage a full assigned workload, maintain QA/compliance standards, support OEP/SEP and service workflows, and provide feedback on state volume, routing, carrier issues, and patient experience. |
● Confirm active resident health license and prior ACA Marketplace enrollment experience.
● Verify PY2026 FFM registration/Exchange agreement by NPN and confirm eligibility to complete PY2027 returning-agent registration.
● Confirm the candidate does not require a release, hierarchy transfer waiting period, or similar approval that would delay Pointcare alignment.
● Confirm assigned western state footprint and calculate any Pointcare-paid nonresident licensing/certification costs before filing.
● Complete background checks, required registrations/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.
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