Manager Customer Service, Enrollment & Premium Billing (Covered California)

CalOptima Health Partnership; Orange (CA); On-site; USD 120,000 - 170,000; Full time

Job summary

CalOptima Health Partnership is seeking a Manager of Customer Service, Enrollment & Premium Billing for the Covered California programs. You will oversee enrollment, premium billing, reconciliation and member account maintenance while ensuring compliance with regulatory standards.

Lead cross-functional teams, drive process improvements, and coordinate with partners to support accurate enrollment, billing and forecasting.

Qualifications

• Bachelor’s degree in business administration, healthcare administration, public administration or related field.
• 5 years of progressive experience in health plan enrollment, eligibility, premium billing, or related operational functions.
• 3 years of management or supervisory experience with direct staff oversight.

Responsibilities

• Oversees daily operations of enrollment, premium billing, payment processing and related activities for Covered California.
• Ensures regulatory compliance and adherence to service delivery standards.
• Provides leadership and strategic direction to support organizational goals and audits.

Skills

Leadership

Project management

Communication

Analytical thinking

Education

Bachelor’s degree in business administration / healthcare administration / public administration

Tools

Microsoft Office

Job description

Join Us in this Amazing Opportunity

The Team You’ll Join

More About the Opportunity

We are hoping you will join us as a Manager Customer Service, Enrollment & Premium Billing (Covered California)and help shape the future of healthcare where you’ll be an integral part of our Premium Billing & Member Enrollmentteam, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to beFull Office.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Manager Customer Service for Enrollment & Premium Billing (Covered California) will be responsible for managing and overseeing the daily operations of enrollment, premium billing, payment processing, reconciliation, delinquency management, grace period administration, terminations, reinstatements and member account maintenance activities for Covered California Individual and Family Plan (IFP) members. You will ensure operational excellence, regulatory compliance and adherence to service delivery standards related to eligibility, enrollment transactions, premium billing and member financial activities. You will collaborate closely with multiple internal teams and outside partners to ensure enrollment and billing activities are completed accurately and on time. You will provide leadership, operational oversight and strategic direction to support organizational goals while maintaining compliance with Covered California, Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care) (DMHC) and applicable federal and state regulations. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Leadership Functions
  • Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
  • Manages employees directly and is responsible for selecting, training, developing, coaching, evaluating and setting department and individual performance goals.
  • Establishes operational priorities and ensures workload distribution supports service level agreements and regulatory requirements.
  • Develops, implements and maintains department policies, procedures and operational controls.
  • Collaborates with leadership to identify opportunities for process improvement, automation and operational efficiencies.
  • Provides strategic input into enrollment, billing and payment forecasting activities.
  • Monitors operational performance metrics and develops action plans to improve productivity, quality and service levels.
  • Ensures staff adhere to all regulatory, contractual and organizational requirements.
  • Establishes and maintains effective relationships with internal and external business partners.
  • Supports audits, regulatory reviews and compliance activities.
  • Leads department projects and operational readiness activities related to Covered California implementations, enhancements and regulatory changes.
• 20% - Enrollment Operations
  • Oversees processing of enrollment transactions received from Covered California, including new enrollments, changes, renewals, cancellations and terminations.
  • Ensures timely and accurate member eligibility maintenance within core administrative systems.
  • Oversees enrollment reconciliation activities between Covered California and CalOptima Health.
  • Monitors enrollment exception processing and resolution activities.
  • Coordinates enrollment-related operational activities with Customer Service, Health Networks and Information Technology teams.
  • Oversees implementation and maintenance of enrollment policies and procedures.
• 25% - Premium Billing Operations
  • Oversees premium billing functions, including binder billing, recurring premium billing, payment processing and member account maintenance.
  • Monitors premium payment activities processed through banking and payment vendors.
  • Ensures accurate premium application, adjustments, refunds and reconciliation activities.
  • Oversees delinquency monitoring, grace period administration, suspension and termination activities.
  • Ensures timely reinstatement processing for eligible members.
  • Oversees reconciliation of enrollment, billing and payment data across multiple systems and vendors.
  • Monitors key billing performance indicators and financial operational metrics.
  • Collaborates with Finance and Accounting departments regarding premium reporting, reconciliation and audit support.
• 5% - Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in business administration, healthcare administration, public administration or related field PLUS 5 years of progressive experience in health plan enrollment, eligibility, premium billing, membership administration or related operational functions required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 3 years of management or supervisory experience with direct responsibility for staff oversight required.

You’ll Stand Out More If You Possess the Following:

• Experience with Covered California Individual and Family Plan (IFP) operations.
• Experience with premium billing and payment processing operations.
• Experience with enrollment reconciliation and 834 transaction processing.
• Experience with CalHEERS.
• Experience with Facets or equivalent health plan administration systems.
• Experience managing operational implementations, testing and system enhancements.
• Experience within a managed care health plan environment.

What the Regulatory Agencies Need You to Possess?

• n/a

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication