X - As-Needed / TEMP - Program Assistant, Enrollment - Covered California

CalOptima

Position Information

• Department: Premium Billing & Member Enrollment
• Salary Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880)
• Work Arrangement: Full Office
• Work Schedule: Monday through Friday; 8:00 a.m. to 5:00 p.m.
• Expected Assignment Duration: up to six (6) months
  
  

Submission Information

• The deadline to be guaranteed full review of your submission is due by November 6, 2026, by 9:00 p.m. PST. This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.
  
  

Duties & Responsibilities

• 95% - Program Support
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Coordinates specialized processes, including eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits for the Medi-Cal program.
• Assists with completing various members requests, such as Change of Health Network Requests, primary care provider (PCP) change requests and data correction forms.
• Responds to questions and interprets policies and regulations.
• Prepares materials (e.g., letters/surveys, etc.) and coordinates data files to arrange for mail merge of materials as applicable.
• Assists with ensuring processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures and policies.
• Represents the Medi-Cal program on projects or as a liaison within or outside CalOptima Health.
• Facilitates communication on specialized topics.
• Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports and Access database procedures.
• Acts as liaison between the Enrollment department and other Customer Service staff.
• Supports with quality assurance audits to validate the accuracy of Protected Health Information / Appointment of Representative (PHI/AOR) and Acceptance Letter updates processed by other staff members.
• Conducts outreach to members for various Enrollment department reasons.
• Conducts outreach to health insurance carriers to verify potential Other Health Coverage (OHC).
• Assists with processing mailed-in member surveys submitted by manually updating members' profiles with various updates, including demographic changes, other health coverage, and address changes.
• Responsible for opening, sorting, reviewing, and tracking of returned mail by maintaining an organized and accurate log to ensure timely submission for monthly text campaigns.
• 5% - Completes other projects and duties as assigned.
  

Minimum Qualifications

• High school diploma or equivalent PLUS 1 year of experience of eligibility and/or reconciliation required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  
  

Preferred Qualifications

• Health insurance experience (Medi-Cal).
• Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and
• Department of Managed Health Care (DMHC) and practices related to Medi-Cal.
• Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting.
• Customer Service experience.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).
  
  

Required Licensure / Certifications

• n/a
  
  

Knowledge & Abilities

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
  
  

Physical Requirements (With Or Without Accommodations)

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds
  
  

Work Environment

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.
  
  

If Located At PACE

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
  
  

If Located In The Community

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
  
  

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

To apply, please visit: https://jobs.caloptima.org/jobs/x-as-needed-temp-program-assistant-enrollment-covered-california-505-city-parkway-west-california-united-states

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