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CAREERS
Health Plan Enrollment Representative
Aya Healthcare - Sutter Health
ABOUT THIS ROLE
Health Plan Enrollment Representative
Sacramento, CA
Note: MUST be legally authorized to work in the United States.
SUMMARY / DUTIES:
REQUIREMENTS:
PREFERRED REQUIREMENTS:
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.
Req3490390
Sacramento, CA
- Schedule: Full-time | Day shift, 8:00 AM - 5:00 PM
- Company Provides all Equipment
Note: MUST be legally authorized to work in the United States.
SUMMARY / DUTIES:
- Health Plan Enrollment Representative supports company's 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.
Req3490390
Amenities
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