Medicare Product Development Lead

001_BCBSA Blue Cross and Blue Shield Association; Chicago (IL); On-site; USD 130,000 - 176,000; Full time

Benefits offered by this job

Annual bonus eligibility

Comprehensive benefits package

401(k) matching

Job summary

001_BCBSA Blue Cross and Blue Shield Association is seeking a Lead Consultant to advance enterprise Medicare Advantage product objectives. The role combines analytical depth, competitive intelligence, and cross-functional coordination across CMS/regulatory, pricing and financial modeling, product, formulary, network, and Stars/Quality strategy.

The Lead Consultant independently conducts market and performance analysis, develops strategic recommendations, and coordinates with Compliance, Legal,

Qualifications

• Bachelor's degree in relevant field or equivalent experience.
• Minimum 7+ years in healthcare product development or Medicare product management.
• Experience coordinating across multiple functions in a regulated environment.

Responsibilities

• Lead benefit design decisions across core and supplemental benefit categories
• Review competitive intelligence and translate insights into benefit configurations
• Partner with actuarial to review cost assumptions
• Drive pricing decisions to support product decisions
• Own product roadmap towards CMS bid cycles and regulatory timelines
• Synthesize regulatory guidance and policy developments for strategy
• Coordinate go-to-market strategy and Plan engagement across MA
• Develop strategic materials and analytical frameworks for compliant member/broker programs
• Coordinate with Plan partners on engagement, distribution, and training
• Monitor performance indicators and adjust to improve penetration and retention

Skills

Medicare Advantage knowledge

Analytical thinking

Cross-functional coordination

Communication and presentation

Regulatory understanding

Education

BS in Healthcare, Business Administration, Public Health, or related field

Tools

Microsoft Office (Word, Excel, PowerPoint)

Data visualization tools

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.

Required Education, Certifications and Experience:

• 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.

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 posting range for this position is: 129,959.06 - 175,749.89

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.

At Blue Cross Blue Shield Association (BCBSA), we are a national association of 33 independent, community-based and locally operated Blue Cross Blue Shield companies and we are driven by purpose. Be part of our storied history of innovation as we advance well-being and health equity. Experience a culture that is built on our core values, connection, work-life flexibility, well-being, and a commitment to our community.

If you thrive at a company that values inclusivity, accountability, courage, teamwork, and respect, we're glad you found us!