Medicare Product Development Lead

Blue Cross Blue Shield Association; Chicago (IL); On-site; USD 130,000 - 176,000; Full time

Job summary

Blue Cross Blue Shield Association in Chicago seeks a Lead Consultant to advance enterprise Medicare product objectives through strategic analysis, market insights, and cross-functional coordination across CMS and regulatory, pricing, and Stars/Quality initiatives.

The role leads benefit design decisions, shapes the product roadmap for CMS bids, supports go-to-market activities, and collaborates with Legal, Compliance, Actuarial, and Operations to deliver insight-driven execution for our MA

Qualifications

• Required BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience
• Required 7+ years experience in healthcare product development, Medicare product management, or health plan operations, with cross-functional coordination
• Knowledge of Medicare Advantage, Part D benefit design, CMS regulatory requirements, and CMS bid cycle process
• Ability to independently execute complex work streams in a regulated environment
• Proficiency in Microsoft Office and data visualization tools; strong communication and presentation skills

Responsibilities

• Lead benefit design decisions across core and supplemental benefit categories, balancing member value, competitive positioning, and margin targets; translate population health insights into benefit configurations for MA EGWP; partner with actuarial on cost assumptions; drive pricing decisions for financial modeling
• Ownership of product roadmap towards CMS bid cycles, regulatory contract requirements and internal governance timelines; synthesize regulatory guidance and policy developments; recommend strategic implications
• Support go-to-market strategy and Plan engagement across the MA function; develop strategic materials and analytical frameworks for compliant member-facing and broker-facing programs; coordinate with Plan partners on engagement, distribution, and training; monitor go-to-market performance and adjust to improve market penetration
• Support broader MA program strategy including Part D formulary, network, and Stars/Quality with cross-functional partners
• Represent the Medicare product function in working groups, advisory forums, and stakeholder discussions; build relationships across the broader BCBSA Medicare ecosystem to enable enterprise-aligned execution

Skills

Medicare Advantage

Regulatory knowledge

Analytical skills

Cross-functional coordination

Stakeholder management

MS Office

CMS bid cycle

Data visualization

Education

BS in Healthcare/Business/Public Health or related field

Tools

HPMS submissions

Job description

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.

Responsibilities Include But Are Not Limited To

• 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.

The Posting Range For This Position Is

129,959.06 - 175,749.89

Education

Required Education, Certifications and Experience:

• 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.

Knowledge Skills and Abilities*

• 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 and data visualization platforms.
• Effective stakeholder coordination and relationship-building skills with the ability to collaborate across Legal, Compliance, Actuarial, Clinical, and Operations functions.
• Understanding of FEHBP program structure and applicable regulatory requirements as they relate to MA EGWP product design and administration preferred.

The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.