Job Description
Job DescriptionJob Title: Health Plan Enrollment Representative
Location: Sacramento, CA
Duration: 52 weeks
Schedule: Day 5x8-Hour (08:00 - 17:00)
Job Description:
Requirements:
- HS diploma or equivalent education/experience
- 1 year recent relevant experience in health plan enrollment, eligibility, insurance, or healthcare operations
- Experience with member/group enrollment, terminations, demographic updates, PCP changes, and eligibility verification
- Experience reconciling eligibility discrepancies, reviewing pending enrollment data, and processing retroactive eligibility changes
- Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint
- Experience with database management, data validation, enrollment system uploads, and file layouts
- Ability to maintain PHI confidentiality and follow audit controls, production standards, and regulatory requirements
- Ability to communicate with brokers, customers, vendors, internal teams, and Member Services to resolve enrollment issues
Preferred Requirements:
- Working knowledge of health insurance enrollment and eligibility practices
- Familiarity with DMHC regulations, managed care, reimbursement models, payer relationships, and pricing mechanisms
- Experience with Microsoft Access, SQL Server, spreadsheet solutions, or FSA file layouts
- Strong attention to detail, organization, time management, and ability to manage multiple priorities
- Analytical, negotiation, and project coordination skills
- Ability to support open enrollment and annual enrollment readiness with cross-functional teams