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Health Plan Enrollment Representative

CoreTechs

Sacramento, CA

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JOB DETAILS
SALARY
$1–$27 Per Hour
SKILLS
Analysis Skills, Brokerage, Communication Skills, Cross-Functional, Customer Acquisition, Data Analysis, Data Quality, Database Administration, Database Technology, Demographics, Detail Oriented, Diversity, File Systems, Flexible Spending Accounts, Health Insurance, Health Plan Membership, Healthcare, Healthcare Reimbursement, Insurance, Inventory Management, Mail Processing, Managed Care, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft SQL Server, Microsoft Word, Multitasking, Negotiation Skills, Operations Planning, Organizational Skills, Pricing, Problem Solving Skills, Production Control, Project/Program Coordination, Reconciliation, Regulations, Regulatory Compliance, Regulatory Requirements, Spreadsheets, Time Management
LOCATION
Sacramento, CA
POSTED
2 days ago
Health Plan Enrollment Representative
Sacramento, CA 95833 – Onsite
  • Schedule: Full-time | Day shift, 8:00 AM-5:00 PM, 5x8 | 52 weeks | Starts 7/27/2026 | Special project
  • Company provides all Equipment

Note: MUST be legally authorized to work in the United States.
 
SUMMARY/DUTIES:
  • Health Plan Enrollment Representative supports Company 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
 
REQUIREMENTS:
  • HS diploma or equivalent education/experience
  • At least 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
 
We are an equal opportunity employer, and we are an organization that values diversity. We welcome applications from all qualified candidates, including minorities and persons with disabilities.
 
req3372780

About the Company

C

CoreTechs

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