We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the direction of the Director of Product Implementation – Medicare & Commercial, the Special Programs Manager I - Commercial Products ensures advancement of IEHP’s commercial product initiatives.
The Covered California Product Specialist is responsible for supporting the development, implementation, maintenance, and regulatory compliance of Individual products offered through the Covered California marketplace.
This role serves as a liaison between internal departments and external stakeholders to ensure successful product filings, regulatory compliance, operational readiness, and ongoing product performance align with IEHP’s Mission, Core Values and Strategic Priorities as defined by IEHP Executives and Leadership.
This role collaborates closely with Compliance, Finance, Actuarial, Sales, Enrollment, Operations, Claims, Provider Network, Marketing, and Covered California representatives to support annual product renewals, regulatory changes, and strategic initiatives.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Product Development & Management: Support the annual Covered California product development and renewal cycle. Coordinate benefit design updates, plan changes, and product enhancements. Maintain product inventories, benefit grids, and product documentation. Assist with evaluating market trends, competitor products, and regulatory requirements. Support implementation of new product offerings and product modifications.
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Support the annual Covered California product development and renewal cycle. Coordinate benefit design updates, plan changes, and product enhancements. Maintain product inventories, benefit grids, and product documentation. Assist with evaluating market trends, competitor products, and regulatory requirements. Support implementation of new product offerings and product modifications.
Regulatory & Compliance Support: Monitor Covered California guidance, regulations, and policy updates. Coordinate review and implementation of Covered California contractual and regulatory requirements. Assist with product filings, Summary of Benefit (SBC), Schedule of Benefit (SOB), Evidence of Coverage (EOC), and benefit documents. Ensure product materials align with state and federal requirements. Participate in regulatory audits and compliance reviews as needed.
Monitor Covered California guidance, regulations, and policy updates. Coordinate review and implementation of Covered California contractual and regulatory requirements. Assist with product filings, Summary of Benefit (SBC), Schedule of Benefit (SOB), Evidence of Coverage (EOC), and benefit documents. Ensure product materials align with state and federal requirements. Participate in regulatory audits and compliance reviews as needed.
Cross-Functional Collaboration: Serve as a key liaison between Product, Compliance, Operations, Enrollment, Finance, Actuarial, and Marketing teams. Facilitate meetings and track action items related to Covered California initiatives. Support enterprise readiness activities for annual renewals and special enrollment periods. Coordinate implementation timelines and project deliverables.
Serve as a key liaison between Product, Compliance, Operations, Enrollment, Finance, Actuarial, and Marketing teams. Facilitate meetings and track action items related to Covered California initiatives.
Support enterprise readiness activities for annual renewals and special enrollment periods.
Coordinate implementation timelines and project deliverables.
Performance Monitoring & Reporting: Analyze membership, enrollment, retention, and product performance data. Develop reports and presentations for leadership and cross-functional stakeholders. Identify opportunities to improve member experience and product competitiveness. Support strategic planning and roadmap development for Covered California products.
Analyze membership, enrollment, retention, and product performance data. Develop reports and presentations for leadership and cross-functional stakeholders. Identify opportunities to improve member experience and product competitiveness. Support strategic planning and roadmap development for Covered California products.
Operational Readiness: Assist with testing and validation of benefit configurations and system updates. Coordinate business readiness activities related to product launches and renewals. Support development of training materials and operational procedures. Participate in issue resolution and corrective action planning.
Assist with testing and validation of benefit configurations and system updates. Coordinate business readiness activities related to product launches and renewals. Support development of training materials and operational procedures. Participate in issue resolution and corrective action planning.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Education & Requirements
A minimum of three (3) years of experience in health plan product management, health insurance operations, regulatory affairs, or related healthcare field required
Experience working with Covered California, ACA products, or Individual Marketplace products preferred
Experience with benefit design, enrollment operations, or healthcare analytics preferred
Project Management certification or equivalent experience preferred
Bachelor’s degree in business administration, Healthcare Administration, Public Health, Finance, or related field from an accredited institution required In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above
In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
This experience is in addition to the minimum years listed in the Experience Requirements above
Master’s degree from an accredited institution preferred
Key Qualifications
Understanding of project lifecycle methodologies and LEAN methodologies
Knowledge of managed care, healthcare, health plans, government products, and/or health plan accreditation principles and practices, enough to effectively lead projects within the organization
Knowledge of health plan operations, including downstream impacts, to effectively implement initiatives
Knowledge of CMS, DHCS, and Covered California requirements preferred
Excellent interpersonal skills
Excellent organizational skills
Excellent communication skills: verbal and written
Excellent organization, process, and project management skills
Skilled in Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, Access, and Project
Ability to work in a complex, rapidly evolving environment which requires high-level initiative
Ability to make quick adjustments to project deadlines or assignments
Ability to work independently and collaboratively within a team environment
Ability to effectively prioritize and manage multiple projects with competing deadlines
Ability to apply knowledge and guide self
Excellent attention to detail
Proven ability to interact effectively at all levels of the organization
Ability to work independently with little or no supervision and able to meet deadlines with little or no planning
Start your journey towards a thriving future with IEHP and apply TODAY !
This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)
About Inland Empire Health Plan
Healthcare4000 employeesFounded 1996
Provides managed healthcare coverage to residents of the Inland Empire.
