Enrollment Representative

Enrollment Representative

Location: Sacramento, CA (Onsite)

Schedule: Full-Time | Monday-Friday | 8:00 AM-5:00 PM

Position Overview

We are seeking a detail-oriented Health Plan Enrollment Representative to support enrollment and eligibility operations for a healthcare plan. This role is responsible for processing member and group enrollments, eligibility updates, terminations, demographic changes, and enrollment record maintenance while ensuring compliance with regulatory requirements and data integrity standards.

The ideal candidate will have experience in health plan enrollment, healthcare administration, insurance operations, or eligibility processing and possess strong analytical, organizational, and customer service skills.

Responsibilities

• Process new member and group enrollments, terminations, and eligibility updates
  
• Maintain accurate member demographic information and primary care provider (PCP) assignments
  
• Verify coverage eligibility and resolve enrollment discrepancies
  
• Review enrollment files for accuracy, completeness, and compliance
  
• Process retroactive eligibility transactions and corrections as needed
  
• Upload, validate, and maintain enrollment data within internal systems and databases
  
• Research and reconcile eligibility issues by collaborating with internal departments and external partners
  
• Generate member correspondence and process requests such as replacement ID cards
  
• Communicate with brokers, customers, vendors, Member Services, and internal teams to gather missing information and resolve enrollment concerns
  
• Analyze transactional data and enrollment activity to ensure data accuracy
  
• Support open enrollment periods, annual enrollment activities, and special projects
  
• Maintain confidentiality of protected health information (PHI) and comply with regulatory requirements and audit standards
  

Required Qualifications

• High school diploma or equivalent combination of education and experience
  
• Minimum one year of recent experience in health plan enrollment, insurance operations, healthcare administration, eligibility processing, or a related field
  
• Member and group enrollment processing
  
• Eligibility verification
  
• Enrollment terminations
  
• PCP changes
  
• Demographic updates
  
• Retroactive eligibility corrections
  
• Proficiency with Microsoft Office Suite, including Excel, Word, and PowerPoint
  
• Experience working with databases, enrollment systems, data validation, and file management
  
• Strong attention to detail and ability to work accurately in a high-volume environment
  

Key Competencies

Data accuracy and quality control

Organization and time management

Critical thinking and analytical skills

Customer service orientation

Ability to manage multiple priorities and deadlines

Collaboration and cross-functional communication

Regulatory compliance and confidentiality awareness

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Pay Details: $25.00 per hour

Search managed by: Savannah Mckillip


Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.


Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.