Health Plan Enrollment Representative

APR Consulting, Inc. has been engaged to identify a Health Plan Enrollment Representative

Job Title: Health Plan Enrollment Representative

Location: Sacramento, CA 95833
Pay Rate: $25.60/hr

Schedule: Full-time | Day shift, 8:00 AM-5:00 PM, 5x8 | 52 weeks | Starts 7/27/2026 | Special project


Summary / Duties:

• Health Plan Enrollment Representative supports the client’s 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.
  

• 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
  
   

• 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
  
   

Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.

 
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.

 

Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.

 

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

 
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!

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