Manager of Product, Commercial Large Group Fully Insured

Medica•St. Louis, MO

9d•$100,300 - $172,000•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across multiple states, focusing on personalized healthcare experiences and provider partnerships. The company culture emphasizes accountability, data-driven decisions, continuous learning, and collaboration. The Manager of Product will be responsible for the development, implementation, and ongoing management of a diverse portfolio of Large Group Fully Insured (LGFI) products within the Commercial Market Division Segment, spanning at least four states and potential expansion areas. This role also involves managing direct reports and collaborating with various Medica departments to assess market needs, develop new products, enhance existing ones, and handle all aspects of state and federal regulatory filings. The Manager will oversee product success, policy document development, timely submissions to CMS and state agencies, and benefit structures, ensuring the intent of product and plan design is maintained and documented. Close collaboration with segment leadership, sales, operations, compliance, legal, network, finance, pharmacy, underwriting, and actuarial teams is crucial for improving market competitiveness, training staff, and ensuring proper administration. The Manager will act as a subject matter expert on assigned product performance (membership, income, MLR, operating margin) and work with leadership on strategies for improvement. This role also contributes to strategic planning by identifying and managing strategic partnerships and external vendors, and collaborates with governmental agencies like CMS and state departments of commerce. Other duties as assigned.

Requirements

Bachelor's degree in health care, business, or related field
5+ years of work experience beyond degree
3+ years of product experience
1+ years of leadership, management and / or team lead experience
Manager-level health plan administration, including experience with senior leadership
Health plan benefit design & implementation
Monitoring product lifecycles & establishing metrics to measure product success
CMS and state compliance and health plan regulatory environment understanding
Understanding of health plan operations
Cross-functional team and project management
Analytical ability in business planning and financial management/acumen
Strategic thinking

Nice To Haves

Strongly preferring Commercial knowledge / experience

Responsibilities

Leads product strategy and project teams to develop and deliver Large Group Fully Insured (LGFI) product solutions.
Collaborates with segment leadership and functional leaders to address product-related issues and identify opportunities for improvement.
Acts as a subject matter expert (SME) on LGFI benefits, including pharmacy coverage.
Interprets federal and state regulatory guidance and ensures compliance in benefit design.
Researches and implements policies aligned with federal and state laws.
Analyzes LGFI programs to identify enhancements in benefits, networks, clinical aspects, and formularies.
Collaborates with finance and actuarial teams to validate findings and recommend improvements.
Understands LGFI products and markets.
Familiar with stop loss insurance, claims platforms, and processes.
Knowledgeable about ERISA and non-ERISA benefits.
Ensures benefit designs align with market trends, member needs, and financial goals.
Manages competitive intelligence gathering for strategic decision-making.
Manages project costs, schedule, and scope using established processes and metrics.
Ensures timely submission and response to contractual reporting requirements from state and federal governments.
Communicates project status and key metrics to all levels of management.
Organizes and analyzes data for internal and external stakeholders.
Leads cross-functional teams to develop new products, programs, tools, and processes.
Prioritizes recommendations related to NCQA measures and consumer demand.
Independently prepares and maintains project documentation.
Summarizes and analyzes results data for senior management.
Utilizes business acumen and analytical skills to identify effective solutions for Medica and vendors.
Develops and maintains partnerships with internal sales and account management teams.
Represents the segment in product-related workgroups within Medica.
Leads Medica’s participation in external work groups with entities such as ACOs/care systems, state regulators, and brokers.
Develops and maintains partnerships with internal sales and account management teams.
Represents the segment in product-related workgroups within Medica.
Leads Medica’s participation in external work groups with entities such as ACOs/care systems, state regulators, and brokers.