Enterprise Fraud and Risk Reporting Manager

Job Description and Duties

Become the Enterprise Fraud and Risk Reporting Manager and join the Program Integrity Division!

Bring your leadership skills to the next level and make a meaningful impact against fraud and abuse. The Program Integrity Division’s Enterprise, Fraud, Risk & Reporting Unit is seeking a dedicated and motivated Supervisor II to join our team and lead efforts in ensuring program accountability and fraud prevention for Covered California.

As the Enterprise Fraud and Risk Reporting Manager, you will oversee a team of professionals dedicated to maintaining the integrity of Covered California and consumers. You will ensure compliance with policies, analyze complex cases, and implement strategies to identify, prevent, and mitigate fraud risks within Covered California’s operations.

Key Responsibilities:

• Provide leadership, guidance, and mentorship to staff.
• Foster a collaborative team environment that emphasizes accountability and promotes continuous improvement.
• Supervise fraud investigations, risk management , and ensure timely and accurate case handling.
• Collaborate with internal and external stakeholders to address fraud-related concerns, risks, and improve program integrity.
• Develop and refine processes on risk management, and strengthen fraud prevention efforts.
• Ensure compliance with state and federal regulations while upholding Covered California’s mission and values.

At Covered California, we recognize our employees are our most valuable asset. We have a variety of career fields that help make a difference in the lives of Californians, and we’re looking for talented and enthusiastic individuals to join our team! Learn more about why you should join the Program Integrity Division.

This position is headquartered in Sacramento County, 1601 Exposition Blvd., Sacramento, CA 95815. Business travel may be required, and reimbursement considers an employee’s designated headquarters office subject to regulations and bargaining unit contract provisions. Travel expenses associated with commuting to the employee’s office headquarters location are not reimbursable, other than authorized transit subsidies.

NOTE: To be considered for this job opportunity, applicants must be reachable on an employment list, have transfer eligibility, or have reinstatement eligibility. If you are new to California State service and you do not have list eligibility, you must take the exam for this classification. To gain employment list eligibility, please click here to access the Supervisor II exam bulletin.

Possession of minimum qualifications will be verified prior to interview and/or appointment. If it is determined an applicant does not meet the minimum qualifications, the applicant's name may be removed from the eligibility list.

Covered California does not provide visa sponsorship and is not an E-Verify employer.

Effective July 1, 2025, in response to the budget deficit, the Department of Human Resources (CalHR) has implemented the Personal Leave Program 2025 (PLP 2025). PLP 2025 requires that each full-time employee working their assigned work schedule receive a 3 percent reduction in pay in exchange for 5 hours of PLP 2025 leave credits monthly through June 30, 2027.

You will find additional information about the job in the .

Working Conditions

This position may be eligible for telework. In accordance with Government Code section 14200, only employees who reside in California are eligible for telework. The amount of telework is at the discretion of the Department and based on Covered California’s current telework policy. While Covered California supports telework, in-person attendance may be required based on operational needs. Employees are expected to be able to report to their worksite with minimal notification if an urgent need arises, as determined by the Department.

Special Requirements

Statement of Qualifications (SOQ) Instructions: A SOQ is required to apply. The SOQ will be used as a pre-interview screening tool. Applicants who do not follow the SOQ instructions and/or do not answer the prompt as stated below may not be considered.

Artificial Intelligence (AI) tools can be useful in the development of written responses; however, it is important to use these tools responsibly and ethically. Where assistive tools may be used, responses within the SOQ should be your own original work. Applicants must write in their own words and avoid plagiarism. Failure to comply may be cause for disqualification.

A Statement of Qualifications (SOQ) must discuss how your education, training, and experience qualifies you for this position. The SOQ must be limited to three pages and should include your full name on each page. It must be formatted in 12-point Arial font and address each of the listed statements below. Responses should be numbered in the same order as they appear.

1. Describe your experience in managing programs by overseeing daily operations, improving performance, and ensuring goals are met.
2. Describe your leadership and management style, including your demonstrated ability to train, mentor, develop, and evaluate staff members to achieve strategic goals.
3. Describe your experience in establishing positive relationships with diverse groups of internal and external stakeholders to foster two-way open communication, build trust, and influence key dialogue.
4. Describe and provide examples of your experience with strategic planning and program management by working collaboratively with internal and external stakeholders.
5. Describe your commitment to valuing diversity and contributing to an inclusive working and learning environment.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

• Minimum of three years of leadership and management experience, with a strong understanding of applicable laws, regulations, and policy requirements, and the ability to ensure compliance while driving strategic goals.

• Strong leadership and management skills to support teams through training, mentoring, and evaluating staff to meet key objectives. Focused on creating a team environment that encourages accountability and continuous improvement.

• Experience establishing positive relationships with diverse internal and external stakeholders to foster two-way open communication, build trust, and influence key dialogue.

• Demonstrated commitment to valuing diversity and contributing to an inclusive working and learning environment.

Benefits

The State of California offers a comprehensive benefits package that includes Health, Vision, Dental, Retirement, and an array of other options. For more information on the benefits offered by the State of California, please click below:

Pre-Employment Requirements

Background Check: All applicants shall be subject to a pre-employment background investigation. The investigation will consist of completion of a pre-employment questionnaire, fingerprinting, and an inquiry to the Department of Justice and Federal Bureau of Investigation to disclose criminal records.

Incompatible Activities: To maintain our integrity and focus on serving Californians, Covered California adheres to unique conflict of interest restrictions on the outside employment and activities of its board members and staff. If you’re considering a role with us, it’s important to know at the time of your start:

• You must not be employed by or otherwise affiliated with health insurance carriers, other insurers, agents, brokers, health care professionals, health facilities, or health clinics, or trade associations of any of these entities. This also means that you must not hold an active license to sell health insurance in California.
• You must not hold an active license to sell health insurance in California.
• Health care professionals are welcome to join our team, provided you do not receive payment for professional services and do not hold ownership or financial interests in a health care practice.

Conflict of Interest: This position is also designated under Covered California’s Conflict of Interest Code. This means if you’re selected to join us, you’ll be required to disclose certain financial interests, including of a spouse, that could potentially interfere with your ability to perform your duties impartially and with the best interests of the public in mind. You may also be disqualified from participating in decisions that may affect those financial interests.

Please email any questions or concerns you may have prior to accepting a final offer of employment to [email protected] .

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is required and must be included.
• Statement of Qualifications -

  Statement of Qualifications (SOQ) Instructions: A SOQ is required to apply. The SOQ will be used as a pre-interview screening tool. Applicants who do not follow the SOQ instructions and/or do not answer the prompt as stated below may not be considered.