Manager, Coverage Distribution Operations

Manager, Coverage Distribution Operations

Location: Remote / Flexible (Remote-first; headquartered in California, multi-state scope)

Employment Type: Full-Time, W-2

Reports to: Head of Patient Operations & Coverage Distribution

Travel: Minimal at launch, with occasional trips for Medicare clinic events and on-site readiness as field programming scales, concentrated around AEP/OEP season, additional company wide onsites expected quarterly

Salary: $90,000-100,000 + Performance Incentive + Benefits

About Pointcare

Pointcare partners with community health centers to help patients keep coverage active, resolve coverage gaps, and access the care they need. We are expanding that work by building a licensed ACA and Medicare coverage distribution function connected to our existing patient base, clinic relationships, app workflows, service introductions, and outreach programs.

This is not a cold-lead insurance sales role. Many patients will be navigating Medicaid loss, Marketplace eligibility, Medicare transitions, dual eligibility, or uninsured/self-pay situations. The right leader will bring strong insurance knowledge, operational discipline, and patient-first judgment.

About the Role

The Manager, Coverage Distribution Operations will help build and operate Pointcare’s ACA and Medicare distribution lane. During launch, you’ll work the queue yourself before anyone else does — taking the first ACA and Medicare calls, testing workflows firsthand, and handling escalations, once authorized — so the systems, scripts, and coaching you build are grounded in real calls, not theory. That firsthand credibility is what lets you lead the team you’ll go on to manage.

As volume grows, you will shift more time toward coaching licensed agents, monitoring quality, managing insurance-specific workflows, recommending staffing changes, and supporting Medicare field/on-site readiness.

What You’ll Do

• Build and refine ACA/Medicare intake, consent, documentation, enrollment, callback, and partner-handoff workflows.
• Act as the team’s first producer during launch — taking ACA and Medicare calls, overflow queues, and complex patient escalations yourself (once properly licensed, certified, appointed, and authorized) to build firsthand knowledge of the workflows you’ll manage.
• Support recruiting, onboarding, readiness tracking, and coaching for licensed seasonal/temp-to-hire agents as the team scales.
• Maintain agent readiness visibility across licenses, AHIP, Marketplace certifications, carrier appointments, ready-to-sell status, and system access.
• Train agents on patient-first communication, approved scripts, consent, disclosures, call documentation, and role boundaries.
• Review recorded calls, monitor QA trends, coach performance gaps, and escalate compliance concerns appropriately.
• Manage insurance-specific Five9 workflows, including queues, skills, dispositions, call-note requirements, SLAs, and workflow feedback.
• Use real data - agent-workable leads, speed-to-lead, backlog, supported states, handling time, and service levels - to recommend when to scale staffing.
• Help design Medicare clinic-event and on-site playbooks, including approved materials, field logistics, and compliance-aligned execution as field operations expand.

What You’ll Bring

Required

• Active health insurance producer license in your resident state, with willingness and ability to obtain nonresident licenses as needed.
• Carrier Appointment Eligibility: Must be able to be appointed with Pointcare’s contracted carriers and FMO. If you hold or have held carrier appointments elsewhere, you must be able to obtain a release from that prior upline. If not already current, you must be willing and able to complete 2027 plan-year AHIP certification, Federally-Facilitated Marketplace (FFM) registration, and any applicable State-Based Exchange (SBE) certification before handling live enrollments.
• 3+ years of practical ACA Marketplace and/or Medicare experience.
• 1+ years coaching, supervising, or leading agents in a phone-based enrollment, call center, agency, health plan, or member-service environment.
• Willingness to take live calls and lead by example during launch, with the expectation that your time shifts toward full-time coaching and operations as the team scales.
• Strong understanding of consent, disclosures, documentation, QA, complaint escalation, and compliant enrollment practices.
• Ability to work cross-functionally with Patient Operations, Licensing, Contracting, Compliance, IT, and external partners.

Strongly Preferred

• Experience across ACA Marketplace and Medicare (Medicare Advantage, Part D, and Medicare Supplement).
• Current AHIP and Marketplace certifications.
• Experience with Five9, HealthSherpa, Sunfire, EDE platforms, carrier portals, or similar tools.
• Experience supporting Medicare educational/marketing events, clinic on-sites, or field-agent workflows.
• Experience building training programs, QA scorecards, dashboards, or launch playbooks.
• Bilingual Spanish/English or other language skills aligned with patient needs.

Benefits & Employment Details

• Travel is minimal at launch, with occasional trips for Medicare clinic events and on-site readiness as field programming scales, concentrated around AEP/OEP season. Approved business travel, mileage, lodging, remote office/cell expenses, and on-site costs are covered by the company. 
• Additional travel for company wide onsites to be expected quarterly. 
• Comprehensive benefits package including no cost employee health, dental, and vision coverage.
• Generous 401(k) policy and employer match of up to 4%. 

First 90 Days

• Build and map workflows, readiness tracking, system needs, and insurance-specific Five9 requirements.
• Train and test call flows through mock calls, QA calibration, certification tracking, and direct producer work when authorized.
• Launch and scale live workflows during AEP/OEP, coach agents, monitor service levels, and recommend staffing changes based on actual demand.