ACA Marketplace Patient Coverage Advisor - West Coast

Workplace: Remote solely
Employment: Full-time

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About this role

Internal Role Description & Hiring Alignment

Patient Operations & Coverage Distribution | Pointcare | September 2026

Title: ACA Marketplace Patient Coverage Advisor

Employment Type: Full-time hourly, 40 hours/week, non-exempt

Location: Remote- West Coast/Pacific Time coverage

Compensation: $24/hour+ ACA Enrollment Incentive + Benefits

1. Role Summary

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.

2. Operating Model

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

3. Patient Base and ACA Distribution Model

● 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.

4. Core Scope of Work

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.

5. Boundaries

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

6. Licensing, Certification and Readiness Requirements

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.

7. Candidate Profile

Required

● 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.

Strongly Preferred

● 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.

8. Compensation and Incentive

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.

9. First 90 Days

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.

10. Pre-Start / Final Offer Requirements

● 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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