Software Guidance & Assistance, Inc., (SGA), is searching for a
Health Plan Enrollment Representative for a
Contract assignment with one of our premier
Healthcare clients in
Sacramento, CA. Responsibilities :
- Health Plan Enrollment Representative supports the firm's 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.
Required Skills:
- 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 Skills:
- 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
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SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work. Please find us at .
SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company to request an accommodation or assistance regarding our policy.
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