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About the role
- Lead the product development, management, and implementation of the California Health Benefit Exchange (Covered CA) and other commercial products
- Partner with the Executive Leadership Team to ensure product and pricing strategies meet strategic priorities
- Collaborate with Vice President of Strategy to determine growth goals, strategies and roadmaps
- Define and monitor product and operational KPIs/performance metrics; drive problem solving and root-cause analysis
- Spearhead continuous process and product performance improvements to meet regulatory, market, consumer, and provider demands
- Ensure rigor in product lifecycle management and complete annual re-certification process
- Provide health care industry expertise and integrate new growth opportunities; identify risks and build mitigation plans
- Drive end-to-end product lifecycle for new products, programs and services when required
- Provide technical guidance and consultation for policies, procedures, and practices
- Ensure timely implementation of requirements through review of industry trends, regulations, laws and legislation
- Serve as the organization's liaison with regulatory and governmental agencies for Exchange and commercial products
- Provide regular updates to Executive Leadership and facilitate quarterly meetings on initiatives, risks, and barriers
- Coordinate with functional teams (Marketing, Sales, Enrollment, Member Services, Care Management, Provider Services, Claims) to resolve issues
- Provide leadership and oversight for annual renewal and implementation projects
- Develop a consolidated annual workplan including milestones, regulatory deliverables, training, and open enrollment readiness
- Hire, train, manage support staff, conduct performance reviews, and monitor outcomes
- Perform other duties as required to ensure Health Plan operations and department business needs are successful
Requirements
- A minimum of ten (10) years of progressive experience in a leadership position within a health plan administration function
- Minimum of five (5) years of experience in a leadership role in the California Health Benefit Exchange markets and product development in a managed care setting
- Demonstrated experience with ACA health plan operations Covered CA or similar state-based health benefit exchange, both implementation and sustainment
- Experience taking an ACA product from inception, design concept to market launch and stabilization
- Experience contracting, implementing, and managing Third Party Administrator or external vendors, including developing and managing service level agreements
- Experience working with brokers to achieve membership, margin, and market-share targets
- Bachelor’s degree in a related field from an accredited institution required
- Master’s degree in a related field from an accredited institution preferred
- Advanced knowledge and deep understanding of managed care, government programs, or other product lines
- Knowledge of healthcare, health plans and/or health plan accreditation principles and practices
- Knowledge of regulatory and compliance requirements related to commercial products, including the California Knox-Keene Healthcare Service Plan Act and Regulations
- Strong interpersonal, verbal and written communication skills
- Excellent organization, process, and project management skills
- Strong analytical skills with emphasis on utilization data to drive operational performance and financial performance
- Ability to quantify impact and ROI of initiatives (preferred)
- Proven ability to implement change in a consultative approach and maneuver in a matrix reporting environment
- Ability to work independently and collaboratively within a team environment and matrix management structure
- Ability to manage multiple products and projects with competing deadlines and changing priorities
- Ability to partner with external partners and work in a complex, rapidly evolving environment
Benefits
- Competitive salary
- Hybrid schedule
- 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
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