Enrollment Specialist

This role responds to eligibility inquiries, generates member correspondence, processes duplicate ID card requests, reviews enrollment submissions for accuracy, and communicates with brokers, customers, vendors, Member Services, and internal teams to obtain missing information or resolve file issues. Responsibilities include entering new enrollments and terminations, updating demographic and PCP information, verifying eligibility status, resolving discrepancies, analyzing transactional data, and submitting retroactive eligibility changes when needed.

Job Title: Health Plan Enrollment Representative
Location: Sacramento, CA 95833
Schedule: Day shift, 8:00 AM-5:00 PM,
Duration: 52 weeks

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

Summary / Duties:
Health Plan Enrollment Representative supports Sutter Health Plan enrollment operations by preparing, processing, uploading, and maintaining member and group registration information in enrollment databases. Responsibilities include entering new enrollments and terminations, updating demographic and PCP information, verifying eligibility status, resolving discrepancies, analyzing transactional data, and submitting retroactive eligibility changes when needed. This role responds to eligibility inquiries, generates member correspondence, processes duplicate ID card requests, reviews enrollment submissions for accuracy, and communicates with brokers, customers, vendors, Member Services, and internal teams to obtain missing information or resolve file issues. The representative also supports data audits, inventory control, regulatory compliance, PHI protection, and open or annual enrollment readiness.