Manager of Product, Commercial Large Group Fully Insured

Medica•Minnetonka, MN

9d•Hybrid

About The Position

The Manager of Product is responsible for development, implementation and ongoing management of a broad portfolio of Large Group Fully Insured (LGFI) products, across four or more states (in addition to possible expansion areas), within the Commercial Market Division Segment, as well as management of direct report(s). This Manager works with numerous Medica functional areas to determine the market need and feasibility for development of new products, enhancements to existing products, and all aspects of regulatory filings at both the state and federal level. The Manager is responsible for overall market success of the products, oversight of policy document development, timely and accurate CMS and state submissions (and meeting of requirements), and benefit structure. The Manager will set, maintain, document and preserve intent of product and plan design. The Manager works closely with segment leadership, sales, operations, compliance, legal, network, finance, pharmacy, underwriting and actuarial, to continuously improve market competitiveness and market position as applicable, communicate and train staff on product details, and ensure proper administration and understanding of product intent. The Manager is subject matter expert on assigned product plan performance, including membership, income, medical loss ratio (MLR) and operating margin, and will work directly with internal leadership on strategies to improve product performance. The incumbent contributes to the strategic planning process for Medica’s Commercial’s product portfolio by identifying, implementing and managing strategic partnerships and external vendors. The Manager collaborates extensively with legal and governmental agencies such as CMS, MN Department of Commerce and regulators in multiple states. Performs 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

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.