The San Francisco Health Plan (SFHP) is a Medi-Cal managed care plan with over 140,000 Medi-Cal members. The health plan also provides Third Party Administrator (TPA) services to the San Francisco Department of Public Health for Healthy San Francisco (HSF), the City Option program and the Healthy Kids (HK) program.
Under the direction of the Manager, Enrollment Services, this position is responsible for supervising a team of enrollment staff and ensuring delivery of exceptional and high quality in-person eligibility and enrollment services to SFHP members, HSF participants, City Option employees, and members of the public seeking health care coverage enrollment assistance and information at the SFHP Service Center.
The candidate for this position must be highly organized with proven experience in an operational client-facing and service-oriented role. Candidate will possess strong verbal and written communication skills, proven multi-tasking and time management skills, and ability to balance the need for structure and adherence to policies and procedures, with the need for flexibility in a constantly changing environment to achieve high level performance and consistent process improvement. Incumbent will have a superior track record of supervising and leading staff from diverse backgrounds to support a high performing, high morale team. Candidates with experience in health insurance enrollment and eligibility, public social services enrollment or health care provider operations, and knowledge of health care regulatory requirements are preferred. A successful candidate will understand the connection between this role and the SFHP Service Center mission of being a credible, empathetic and helpful resource for clients seeking assistance applying or enrolling into San Francisco health coverage programs.
WHAT YOU WILL DO
- Directly supervises a staff of 8 – 10 enrollment staff to ensure they are appropriately trained and certified according to their job responsibilities, adhering to protocol or policy and providing superior service to clients.
- In collaboration with the SFHP Service Center management team, demonstrates effective leadership to support high employee satisfaction and morale. Promotes and implements rigorous training curricula for new and existing staff providing in-person services. Establishes effective performance monitoring tools and reporting to ensure accurate, consistent enrollment services that meet required compliance standards.
- Works both independently and within a team environment to respond to departmental changes and staff and management requests in a timely manner.
- Ensures the accurate and efficient delivery of SFHP’s enrollment & eligibility services including application assistance, health coverage eligibility navigation, and accurate answering of client inquiries for Medi-Cal, CalFresh, Medicare, Healthy Kids, Covered California and other health coverage programs.
- Ensures the Enrollment Services staff at the SFHP Service Center adheres to California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and other local, state, and federal rules, regulations, and policies applicable to health coverage application assistance and marketing.
- Adheres to professional codes of conduct, including those stipulated by health coverage program requirements, DHCS Marketing Guidelines, Service Center policies and procedures and departmental expectations.
- Maintains program expertise, training requirements, and certifications for all application assistance services offered by the SFHP Service Center, including Medi-Cal, Covered CA (Medi-Cal Managed Care Plan Enroller training and certification), Healthy San Francisco (HSF Application Assistor training), and Healthy Kids (HK Application Assistor training).
- Develops and implements policies and procedures, including measuring results against standards and making necessary adjustments.
- Participates, as needed, in community outreach activities such as special Service Center Enrollment Events, to support membership and retention in health coverage programs.
- Produces high-quality program or performance reporting to management to satisfy contractual obligations, operational and performance monitoring, or requests from management.
- Provides assistance with on-the-job training for new employees.
- Initiates and/or assists in the development of new tools and resources for the enrollment team and staff.
WHAT YOU WILL BRING
- 2 years of relevant work experience in a healthcare, public benefits, or social services environment.
- College degree required; Bachelor’s degree preferred.
- 3 years in a supervisory role with direct reports preferred.
- Minimum 1 year in a customer service role providing direct services to clients. Experience with in-person services preferred.
- Certified Covered California Enrollment Counselor with prior experience assisting clients in applying for Covered California, Medi-Cal, CalFresh, Healthy Kids and/or Healthy San Francisco preferred.
- Fluent bilingual skills including English. Spanish or Cantonese/Mandarin preferred.
- Ability to work with complicated rules and policies and collect and process confidential and personal health information with competence, care and discretion.
- Demonstrated familiarity and understanding of public health insurance programs in California and San Francisco. Familiarity with managed care or Medi-Cal preferred.
- Ability to create a positive and healthy work environment for a team of employees with a range of experiences and cultural backgrounds.
- Ability to establish standard expectations for staff performance and evaluate, coach or mentor staff to reach high levels of performance.
- Ability to comprehend, interpret and comply with complex rules and regulations, including privacy and compliance standards, program eligibility rules and processes.
- Exemplary interpersonal and customer service skills. Demonstrated ability to communicate (verbal and written) program rules and policies in clear, understandable terms accurately and professionally to various audiences and individuals of diverse backgrounds. Ability to manage interpersonal interactions with poise, tact and sensitivity.
- Demonstrates consistent good judgment, organization and prioritization skills, and time management skills.
- Strong computer skills, including high proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint). Experience with eligibility applications such as One-e-App, CalHEERS, mybenefitsCalWIN etc. is desirable.
- Detail oriented, with a proven ability to produce accurate and precise work, detect discrepancies and resolve discrepancies while meeting deadlines.
- Experience in effectively working individually and within a team.
- Must be able to work at the SFHP Service Center at 7 Spring Street in San Francisco during the core hours of: Monday – Friday: 8:00 am – 5:00 pm; periodically during extended hours of overtime which may include weekdays between 5:00 pm and 8:00 pm or weekend hours, as necessary.
- Must demonstrate excellent attendance.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.