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

Join us in this mission-driven, community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

About the role

As Manager of Customer Service, Enrollment & Premium Billing (Covered California), you will shape the future of healthcare by leading our Premium Billing & Member Enrollment team. This position is approved for full office work; if telework is approved, you must work within the State of California and, for partial telework, report to the main office in Orange, CA at least two days per week.

You will oversee daily operations of enrollment, premium billing, payment processing, reconciliation, delinquency management, grace period administration, terminations, reinstatements, and member account maintenance for Covered California Individual and Family Plan (IFP) members. Your role ensures operational excellence, regulatory compliance, and adherence to service delivery standards related to eligibility, enrollment transactions, premium billing, and member financial activities.

Collaborating with internal teams and external partners, you will ensure accurate and timely completion of enrollment and billing activities while maintaining compliance with Covered California, CMS, DMHC, and applicable federal and state regulations.

Responsibilities

• Leadership Functions (50%)
  • Cultivate and promote a mission-driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
  • Direct and assist the team in carrying out department responsibilities; collaborate with leadership to support short- and long-term goals.
  • Manage employees directly, including selection, training, development, coaching, evaluation, and setting performance goals.
  • Establish operational priorities and ensure workload distribution supports service level agreements and regulatory requirements.
  • Develop, implement, and maintain department policies, procedures, and operational controls.
  • Identify opportunities for process improvement, automation, and operational efficiencies.
  • Provide strategic input into enrollment, billing, and payment forecasting activities.
  • Monitor operational performance metrics and develop action plans to improve productivity, quality, and service levels.
  • Ensure staff adherence to all regulatory, contractual, and organizational requirements.
  • Establish and maintain effective relationships with internal and external business partners.
  • Support audits, regulatory reviews, and compliance activities.
  • Lead department projects and operational readiness activities related to Covered California implementations, enhancements, and regulatory changes.
• Enrollment Operations (20%)
  • Oversee processing of enrollment transactions from Covered California, including new enrollments, changes, renewals, cancellations, and terminations.
  • Ensure timely and accurate member eligibility maintenance within core administrative systems.
  • Oversee enrollment reconciliation activities between Covered California and CalOptima Health.
  • Monitor enrollment exception processing and resolution activities.
  • Coordinate enrollment-related activities with Customer Service, Health Networks, and Information Technology teams.
  • Oversee implementation and maintenance of enrollment policies and procedures.
• Premium Billing Operations (25%)
  • Oversee premium billing functions, including binder billing, recurring premium billing, payment processing, and member account maintenance.
  • Monitor premium payment activities processed through banking and payment vendors.
  • Ensure accurate premium application, adjustments, refunds, and reconciliation activities.
  • Oversee delinquency monitoring, grace period administration, suspension, and termination activities.
  • Ensure timely reinstatement processing for eligible members.
  • Oversee reconciliation of enrollment, billing, and payment data across multiple systems and vendors.
  • Monitor key billing performance indicators and financial operational metrics.
  • Collaborate with Finance and Accounting departments regarding premium reporting, reconciliation, and audit support.
• Other Duties (5%)
  • Complete other projects and duties as assigned.

Requirements

• Bachelor’s degree in business administration, healthcare administration, public administration, or a related field plus 5 years of progressive experience in health plan enrollment, eligibility, premium billing, membership administration, or related operational functions. An equivalent combination of education and experience may also qualify.
• 3 years of management or supervisory experience with direct responsibility for staff oversight.

Preferred Qualifications

• 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.

Skills

• Develop rapport and maintain effective working relationships with leadership, staff, and external contacts at all levels.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including evenings and weekends as needed.
• Organize, analyze, problem-solve, and manage projects effectively.
• Work efficiently in a fast-paced environment and manage multiple projects.
• Identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Proficient in Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, and body movement (bending, crouching, walking, kneeling, prolonged sitting).
• Ability to lift and move objects, patients, and/or equipment under 10 pounds.

Benefits

• Competitive compensation: Pay Grade 313 – $90,820 - $145,312 annually ($43.66 - $69.86/hour). Final salary based on education, experience, skills, and internal equity.
• Comprehensive benefits package and CalPERS pension program.
• Generous PTO program and work-life balance initiatives.
• Wellness programs, tuition reimbursement, and professional development opportunities.
• Career development and flexible scheduling options.

Schedule

This position is approved for full office work. If telework is approved, it must be performed within the State of California. Partial telework requires reporting to the main office in Orange, CA at least two days per week.

Work Environment

• 500/505 Building or Remote: Typically indoors and sedentary, subject to schedule changes, variable hours, and travel. Noise level is usually moderate.
• PACE: Typically indoors in a clinical setting serving frail and elderly members. May involve harmful or hazardous conditions. Noise level is usually moderate to loud.
• Community: Typically indoors and sedentary, subject to schedule changes, variable hours, and travel. Occasional outdoor work in varied temperatures. May involve harmful or hazardous conditions. Noise level is usually moderate to loud.