Supervisor Customer Service, Member Enrollment

CalOptima; Orange (CA); Hybrid; USD 64,000 - 103,000; Full time

Benefits offered by this job

Partial Telework

CalPERS pension

PTO (generous)

Tuition Reimbursement

Flexible scheduling

Wellness programs

Job summary

CalOptima in California seeks a Supervisor Customer Service (Member Enrollment) to lead the Enrollment & Reconciliation team. You will guide staff on eligibility, address complex member questions, and coordinate with IT, SSA, and CMS for resolutions.

Partial telework is approved with in-state presence at the Orange, CA main office at least two days per week. You will manage priorities, coach staff, and help ensure CMS/DHCS regulatory compliance while supporting the overall mission of providing

Qualifications

• High school diploma or equivalent PLUS 2 years of experience with a health plan or in a clinical environment.
• 2 years of lead or supervisory experience required.
• Experience in managed care and/or government programs required.

Responsibilities

• Oversee day-to-day operations of the Enrollment & Reconciliation department.
• Provide guidance to staff on eligibility issues for CalOptima Health.
• Stay current on state and federal regulatory changes and updates.
• Collaborate with internal and external stakeholders for member resolution.
• Support CMS and DHCS regulatory compliance and staff training.

Skills

Leadership

Customer service

Communication

Problem solving

Project management

Analytical

Team coaching

Education

Bachelor's degree in health care / health administration

Job description

Supervisor Customer Service, Member Enrollment

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Supervisor Customer Service, Member Enrollment and help shape the future of healthcare where you'll be an integral part of our CS - Enrollment Reconciliation & Member Communications team, 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 be Partial Telework.

- 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 Supervisor Customer Service (Member Enrollment) is responsible for overseeing the day-to-day operations of the Enrollment & Reconciliation (E&R) department activities while supervising E&R staff. You will provide guidance to E&R staff on addressing and resolving member eligibility issues for Customer Service and other departments within CalOptima Health. You will be accountable for staying current on the latest state and federal regulatory changes and updates. In this role, the supervisor will be the point of contact for eligibility issues and will work closely with internal and external stakeholders for the resolution of member issues. Additionally, you will typically handle more difficult or complex questions and concerns regarding members' eligibility status. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Program Support
• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Serves as the point of contact for eligibility issues and works closely with other Customer Service Supervisors, Information Technology (IT), Social Security Administration (SSA), contracted vendors, the Department of Health Care Services (DHCS), and/or the Center for Medicare & Medicaid Services (CMS) for member resolution.
• Assists with developing, documenting and updating regulatory and departmental compliance desktop policies and procedures.
• Maintains compliance by understanding state and federal regulatory guidance and abiding by policies and procedures (P&Ps) that meet all requirements.
• Troubleshoots eligibility and enrollment issues for affected departments.
• Resolves customer dissatisfaction through investigating, settling issues and resolving escalated and complex situations as needed.
• Recognizes and resolves problems impacting department processes by collecting and analyzing information; communicates suggestions to management and develops/implements solutions as appropriate.
• Partners closely with ITS to ensure accuracy of member eligibility and reporting.
• Assists with providing education/orientation about CalOptima Health benefits to both beneficiaries and community agencies as needed.
• 45% - Supervision
• Assigns priorities for the team to ensure tasks are completed and performance goals are met, such as timely completion of CRM enrollment/disenrollment/change requests, timely processing of CMS issued transaction reply codes (TRCs) and escalated member grievance issues.
• Supervises and manages the performance of the member enrollment team for production, accuracy, timeliness, and efficiency.
• Monitors eligibility activities and productivity standards.
• Facilitates staff performance by coaching, counseling, and disciplining employees: planning, monitoring, and evaluating job results.
• Holds monthly one-on-one meetings, team meetings with direct reports, and discusses performance results and developmental opportunities.
• Collaborates with the Manager of E&R to develop strategies to reinforce, train and disseminate information to ensure CMS and DHCS regulatory compliance.
• Supports the hiring process by reviewing resumes, participating in interviews and recommending candidates.
• 5% - Other
• Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• High school diploma or equivalent PLUS 2 years of experience with a health plan, health program or in a clinical environment working with culturally diverse populations 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.
• 2 years of lead or supervisory experience required.
• Experience in managed care and/or government programs required.

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

• Bachelor's degree in health care, health administration, business administration or related field of study.
• Professional education or experience in enrollment and eligibility or health care management.

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.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
• Our current hiring range is: Pay Grade: 308 - $64,165 - $102,664 ($30.85 - $49.3577).
• The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
• A https://www.caloptima.org/en/careers#benefits
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunitiesCareer development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at [phone] if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.