OverviewUnder 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.
Additional BenefitsPerksIEHP 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
Key Responsibilities- 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.
- 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.
- 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.
- 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.
- 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.
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
QualificationsEducation & 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 coordinating cross-functional healthcare projects 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
- 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!Work Model LocationThis position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)
Pay RangeUSD $80,059.20 - USD $106,059.20 /Yr.
