Medicare Product Development Lead

Job Description

Summary:

This role operates as a strategic resource across the Medicare Advantage (MA) function, bringing analytical depth, competitive intelligence, and cross-functional coordination to advance enterprise Medicare product objectives. This position will address the highest-priority needs of the MA program and strategy across CMS/regulatory, pricing and financial modeling, product, formulary, network, Stars/Quality strategy in addition to broader programmatic execution. The Lead Consultant independently conducts market and performance analysis, develops strategic recommendations, and coordinates across functional partners to ensure cohesive, insight-driven execution.

This position collaborates with Compliance, Legal, Actuarial, Clinical, Network, Sales, and Operations teams and serves as a connective resource across the MA function to advance both near-term deliverables and longer-term strategic initiatives.

• Lead benefit design decisions across core and supplemental benefit categories, balancing member value, competitive positioning, and margin targets.
• Reviews competitive intelligence, translate population health insights and utilization data into benefit configurations that differentiate the MA EGWP offering.
• Partner with actuarial to review benefit cost assumptions against enrollment and risk score scenarios.
• Drive strategic framing of pricing decisions driving financial modeling to support product decisions.
• Ownership of product roadmap towards CMS bid cycles, other regulatory contract requirements and internal governance timelines.
• Supports synthesis of regulatory guidance, sub-regulatory memos, and policy developments, recommending strategic implications and product strategy adjustments for team consideration.
• Supports go-to-market strategy support and Plan engagement coordination across the MA function.
• Develops strategic materials and analytical frameworks to support compliant member-facing and broker-facing program execution in partnership with Sales and Field Services.
• Coordinates with Plan partners on engagement activities, distribution strategy, and training support.
• Monitors go-to-market performance indicators and recommends strategic adjustments to improve market penetration, member acquisition, and retention outcomes.
• Supports broader MA program strategy including Part D formulary strategy, network strategy and Stars/Quality strategy with cross functional partners.
• Serves as a connective resource across the MA organization, coordinating with functional leaders, Plan partners, and enterprise stakeholders to advance cross-cutting priorities.
• Represents the Medicare product function in working groups, advisory forums, and stakeholder discussions, bringing analytical perspectives and strategic context.
• Builds and maintains effective relationships across the broader BCBSA Medicare ecosystem to support integrated, enterprise-aligned program execution.

• Education:
  
  Required BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience
• Experience:
  
  Required 7+ Years Experience in healthcare product development, Medicare product management, or health plan operations, with a track record of independent execution and cross-functional coordination.

• Proficient knowledge of Medicare Advantage and Part D benefit design, CMS regulatory requirements, and the annual bid cycle process (HPMS submissions, benefit package configuration, regulatory review).
• Demonstrated ability to independently execute complex work streams, coordinate across multiple functions, and manage concurrent deliverables in a regulated environment.
• Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and quality/Stars metrics to drive benefit enhancement decisions.
• Strong written, oral communication, and presentation skills; ability to develop clear analytical materials and represent workstream findings to senior stakeholders.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint); familiarity with project management tools…