Director-Premium Billing and Member EnrollmentThe Judge Group • Orange, CA, US
Director-Premium Billing and Member Enrollment
The Judge Group • Orange, CA, US
[job_card.variable_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]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. 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. Prior experience at a health plan leading enrollment and billing functions for exchange or commercial products. Specific experience with Covered California. 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. Comprehensive benefits package including pension program, retirement plans, generous PTO, wellness programs, tuition reimbursement, professional development, flexible scheduling, and career growth opportunities. Primarily indoors and sedentary, with variable work hours and occasional travel. May include clinical or community settings depending on assignment. Noise levels range from moderate to loud depending on location.
Director Premium Billing and Member Enrollment (Director II)
Work type : Full Time
About the Role
We are seeking a strategic thinker with a proven track record of leading high-performing teams to establish and manage the Enrollment and Billing function related to Health Insurance Exchange / Marketplace / Covered California product operations. This role is critical in building and executing seamless enrollment, accurate billing, and regulatory compliance for product line expansion.
As Director, you will define and scale your team, create a roadmap, implement operational processes, and close gaps in people, process, and technology to support enrollment and billing capabilities for the Covered California line of business. You will play a key role in strengthening revenue recognition processes, supporting managed care contract modeling, and maintaining reimbursement estimation tools used for forecasting and financial planning.
Responsibilities
Leadership Functions (45%)
- 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.
Program Oversight (50%)
Other (5%)
Minimum Qualifications
Preferred Qualifications
Skills & Abilities
Compensation & Benefits
Work Environment
[job_alerts.create_a_job]
Enrollment Billing • Orange, CA, US
[internal_linking.similar_jobs]
Make a greater impact at Bonduelle Americas!.Bonduelle Americas is a certified B Corp inviting people to embrace a flexitarian lifestyle with an expanding portfolio of plant-rich products available...[show_more]
At H&R Block, we believe in the power of people helping people.Our defining Purpose is to provide help and inspire confidence in our clients, associates, and communities everywhere.We also believe ...[show_more] Make a greater impact at Bonduelle Americas!.Bonduelle Americas is a certified B Corp inviting people to embrace a flexitarian lifestyle with an expanding portfolio of plant-rich products available...[show_more] 
Join the Fire Safety First Team!.FSF has been successful in serving SoCals fire protection needs for nearly 50 years.Since then we have grown into a dynamic team of creative minds and professionals...[show_more]
Account Director is a key role in C&W with responsibility to manage the client relationship while providing exceptional client service and delivering on all aspects of the contract.Account Dire...[show_more]
Cooks, Dishwashers, and Prep Cooks.Every day, we handcraft delicious food using all-natural ingredients, from hand-cut fries to freshly baked buns, and take pride in creating meals that make people...[show_more]
We are seeking dedicated Tool Crib Attendants for a large defense company located in Santa Ana / Costa Mesa, CA.The position is for the second shift from 11am-11 : 30pm (flexible on times).These roles ...[show_more]
We are seeking experienced Medicare Senior Billers to join our team on an ongoing contract basis.Manage end-to-end Medicare and Managed Medicare & Medi-Cal billing processes, ensuring complianc...[show_more]
Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals in recovering their health, hopes, and dreams.
Telecare continues to advance cultural dive...[show_more]
Email your word document resume to.We are seeking an experienced and strategic Director of Payroll to lead and optimize all payroll operations for our organization.
This role oversees payroll proces...[show_more]
Online Order Filling Team Associate.WM Supercenter #2609 2770 Carson St Lakewood, CA 90712-4004 CP-2609-9038.Part time Shift may start between 8 : 00am - 4 : 00pm.
Online Order Filling associates have o...[show_more]
The Payroll Manager oversees all payroll operations to ensure accurate and timely processing for employees.This role manages payroll staff, maintains compliance with federal and state regulations, ...[show_more]
TheCollector / Billerperforms various routine clerical tasks dealing with all insurance billing; and works with other clinic personnel patients and visitors to maintain positive internal and public r...[show_more]
Our client is a privately held industry leader with numerous locations throughout the United States.They are experiencing exciting growth and seeking a Benefits Manager or Director to join their gr...[show_more]
University of California, Irvine, and the only academic health system based in Orange County.UCI Health is comprised of its main campus,.
UCI Health Community Network in Orange and Los Angeles count...[show_more]
Processing Associate 2nd shift.People with a sense of purpose and integrity.People with a relentless pursuit of excellence.
People who care about making things better For Those Who Make The World.So...[show_more]
DESCRIPTION OF EMPLOYEE’S JOB DUTIES.The Order Puller receives and processes incoming and outgoing orders for materials, and / or merchandise to satisfy customer requests.Verify customer and or...[show_more]
Founded in 1978, we rank among the top 100 law firms identified by The American Lawyer and 36 in the National Law Journal's survey of the nation's largest law firms.
We're also Mansfield Certified P...[show_more]
General Labor - Bistro PM
Ready Pac Produce, Inc • Baldwin Park, CA, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Associate Team Leader
H&R Block • Pasadena, CA, US
[job_card.full_time] +1
[last_updated.last_updated_30] • [promoted]
General Labor - Salads AM
Ready Pac Produce, Inc • Baldwin Park, CA, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Senior Billing Specialist
Fire Safety First • Santa Ana, California, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Sr. Account Director
Cushman & Wakefield • Costa Mesa, California, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
BOH
HiBar Hospitality Operations LLC • Newport Beach, CA, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Tool Crib Attendant
Aerotek • Santa Ana, CA, US
[job_card.full_time]
[last_updated.last_updated_variable_hours] • [promoted] • [new]
Medicare Hospital Biller
Insight Global • Anaheim, CA, US
[job_card.full_time]
[last_updated.last_updated_1_day] • [promoted]
Billing Specialist : Multi Sites - Orange County Region
Telecare Corporation • Santa Ana, CA, United States
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Director of Payroll
Conexus • Santa Ana, CA, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Online Order Filling Team Associate
Sam's Club • Lakewood, CA, US
[job_card.full_time] +1
[last_updated.last_updated_variable_days] • [promoted]
Payroll Manager
Vaco by Highspring • Huntington Beach, California, United States
[job_card.permanent]
[last_updated.last_updated_variable_days] • [promoted]
CollectBiller
PIH Health • Whittier, California, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Benefits Manager
Consultative Search Group • Buena Park, California, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Biller III (Cash Posting) - HB Enterprise Reporting - FT Days
University of California - Irvine Health • Anaheim, CA, United States
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Processing Associate–2nd Shift, 21.00hr + 12 Shift Premium +Incentive Bonuses
Stanley Black & Decker • Fullerton, California, USA
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Order Puller - 2nd Shift
Ganahl Lumber Co • Pasadena, CA, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Employment and Labor Associate
Wilson Elser Moskowitz Edelman & Dicker LLP • Costa Mesa, CA, United States
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]