Details
Posted: 29-Oct-25
Location: Houston, Texas
Type: Full Time
Categories:
Operations
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
* Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
JOB SUMMARY
The Broker Relations Services Representative facilitates broker and producer engagement by assisting with onboarding, licensing, compliance, and system access issues. They facilitate broker contracting by reviewing applications, conducting background checks, and ensuring adherence to federal, state, and company regulations. Managing the broker portal, they oversee document processing, maintain accurate records, and ensure compliance with auditing requirements. Collaboration with internal teams is key to streamlining processes, enhancing broker support services, and conducting training sessions on the use of company tools, systems, and portals to ensure efficient navigation and utilization of available resources. Additionally, they contribute to departmental goals, process improvements, and system enhancements related to broker management.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Broker & Producer Support:
Facilitates broker and producer engagement by assisting with onboarding, licensing, compliance, and system access issues.
Provide guidance on licensing, certification, and continuing education requirements for brokers selling health insurance plans.
Assist brokers with system access, password resets, and troubleshooting portal-related issues.
Educate brokers on company policies, procedures, and on the use of company tools, systems and portals to ensure efficient navigation and utilization of available resources.
Contracting & Compliance Management:
Facilitate the end-to-end broker onboarding process, including application review, background checks, and contract execution.
Ensure compliance with federal, state, and company regulations governing broker contracts and licensing.
Process Office of Inspector General (OIG) reports and maintains up-to-date documentation for auditing purposes.
Monitor and track agent/broker licensing, ensuring renewals and certifications are completed in a timely manner.
Collaborate with legal and compliance teams to ensure all broker agreements adhere to industry standards and regulations.
Portal & Document Management:
Oversee and maintain the broker portal, ensuring all broker data, commission statements, and training materials are accurate and updated.
Process broker-submitted documents in the Community Health Choice broker box, verifying completeness and compliance.
Maintain accurate records of broker contracts, licensing, and terminations in company systems.
Conduct periodic data audits to ensure accuracy and integrity of broker information.
Cross-Functional Collaboration & Process Improvement:
Work closely with internal departments, including Sales, Compliance, Legal, and IT, to streamline broker-related processes.
Identify opportunities to enhance broker support services and improve overall broker experience.
Assist in the development and execution of broker training sessions, webinars, and informational meetings.
Participate in system enhancements and testing related to broker management tools and portals.
Actively contributes to the achievement of departmental goals, as identified in the Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.
Education/Specialized Training/Licensure: High school diploma required with 1-2 years of experience in contracting, compliance, healthcare, or insurance.
Work Experience (Years and Area): Previous experience in contracting, compliance, licensing, or producer support within the health insurance industry is highly desirable required.
Software Proficiencies: Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and experience with CRM or broker management systems.
Other:
Knowledge of state and federal regulations, including CMS guidelines, ACA & Medicare compliance, and broker licensing requirements.
Excellent customer service and relationship management skills.
Strong attention to detail with exceptional organizational and problem-solving abilities.
Ability to handle sensitive and confidential information with discretion.
Self-motivated with the ability to work independently and collaboratively in a fast-paced environment.
