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The Judge Group · 1 month ago

Director-Premium Billing and Member Enrollment

Orange, CA

Full-time

Onsite

Director/Executive

$180K/yr - $290K/yr

7+ years exp

The Judge Group is seeking a strategic thinker to lead the Enrollment and Billing function related to Health Insurance Exchange operations. This role involves managing high-performing teams, implementing operational processes, and ensuring regulatory compliance for product line expansion in Covered California.

E-LearningInformation TechnologyProfessional Services

Hiring Manager

Sherry Gambone

Responsibilities

Cultivate and promote a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability

Direct, hire, and train department managers and staff; set monthly or quarterly goals

Serve as the key advisor for executive leadership on strategic decisions impacting Enrollment and Billing operations

Develop and execute a 12–18-month roadmap to operationalize Enrollment and Billing capabilities for Covered California, integrating with existing workflows and configuring systems to support new processes

Build and lead the Enrollment and Billing function, including recruiting, coaching, and retaining staff, establishing governance structures, and collaborating cross-functionally

Oversee timely and accurate completion of Covered California enrollment processes, including ingestion and processing of 834 enrollment files, plan changes, cancellations, and grace-period management

Implement and oversee end-to-end premium billing capability, including invoice generation, member payments, financial reconciliation (including subsidies), and refunds

Reconcile membership and premium data with Covered California and internal systems to ensure regulatory compliance and data accuracy

Manage enrollment and billing processing and reconciliation for off-exchange populations

Oversee integration and management of enrollment and billing capabilities handled by third-party vendors and delegated networks

Lead vendor and technology selection for vended capabilities and oversee implementation and integration with organizational processes and technologies

Partner with IT and vendor teams to configure core admin systems, oversee system/data integrations, and optimize premium billing capabilities

Develop and manage the annual departmental budget

Complete additional projects and duties as assigned

Qualification

Health insurance exchange experienceEnrollmentBilling managementLeadership experienceAnalytical skillsMicrosoft Office proficiencyProject management skillsRelationship-building skillsProblem-solving skillsCommunication skills

Required

Bachelor's degree in business, health administration, finance, or related field (Master's preferred)

7+ years in health-plan operations, with at least 5 years in health insurance exchange/marketplace and/or commercial Individual and Family Plan (IFP) enrollment and billing

3+ years of progressive management/leadership experience

Must have Covered California experience

Strong leadership and relationship-building skills across diverse teams and stakeholders

Ability to work independently, exercise sound judgment, and communicate clearly

Analytical, problem-solving, and project management skills in fast-paced environments

Ability to manage multiple projects, motivate teams, and identify opportunities for collaboration

Proficiency in Microsoft Office and job-specific applications/systems