Manager Customer Service, Enrollment & Premium Billing (Covered California)
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 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 Enrollment 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 Full 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.
- 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 less than 10 pounds
Ways We Are Here For You
- You'll enjoy competitive compensation for this role. - Our current hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615). - 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 Full Office (**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 opportunities
- Career 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.
What's Your Next Step?
All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is August 16, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
Our Commitment to You
Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.
We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.
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 (714) 246-8400 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.
To apply, please visit: https://apptrkr.com/9743610
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