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: Enrollment Specialist
Location: Sacramento, CA
Duration: 52 weeks
Shift: Day 5x8-Hour (08:00 - 17:00)

Job Description:

Health Plan Enrollment Representative supports 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.

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