Medicare Product Development Lead

Blue Cross and Blue Shield of Kansas Inc.; Chicago, Northern (IL, KY); Hybrid; USD 130,000 - 183,000; Full time

Benefits offered by this job

Paid time off

11 holidays

Medical/dental/vision insurance

Generous 401(k) matching

Lifestyle spending account

Job summary

Blue Cross Blue Shield Association (BCBSA) in the United States seeks a Lead Consultant to drive Medicare Advantage product strategy and cross-functional execution. You will coordinate with Compliance, Legal, Actuarial, Clinical, Network, Sales, and Operations to align regulatory, pricing, and program design with enterprise goals.

The role requires deep analytics, market intelligence, and leadership to shape benefit configurations, roadmap decisions, and go-to-market plans across CMS bid cycles

Qualifications

• BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience.
• 7+ years experience in healthcare product development, Medicare product management, or health plan operations.
• Ability to independently execute and coordinate across functions.

Responsibilities

• Lead benefit design decisions across core and supplemental benefit categories.
• Review competitive intelligence and translate population health insights into benefit configurations.
• Partner with actuarial to review benefit cost assumptions against enrollment and risk score scenarios.
• Drive pricing decisions and financial modeling to support product decisions.
• Own product roadmap towards CMS bid cycles, regulatory requirements and governance timelines.
• Synthesize regulatory guidance and policy developments; adjust product strategy accordingly.
• 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 program execution.
• Coordinate with Plan partners on engagement activities, distribution strategy, and training support.
• Monitor go-to-market performance and adjust to improve penetration, acquisition, and retention.
• Support MA program strategy including Part D formulary, network, and Stars/Quality with cross-functional partners.
• Represent Medicare product function in working groups and stakeholder discussions with analytical input.
• Build and maintain relationships across the BCBS Medicare ecosystem for enterprise-aligned execution.

Skills

Analytical thinking

Cross-functional coordination

Communication

Stakeholder management

Regulatory knowledge

Education

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

Tools

Excel

PowerPoint

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 - 182,684.02

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 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.

• Paid time off
• 11 holidays
• Medical/dental/vision insurance
• Generous 401(k) matching
• Lifestyle spending account
• 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. Join the team who supports the nation's largest healthcare network, providing coverage to nearly one in three Americans as we relentlessly pursue affordable healthcare and ensure peace of mind for the people we serve. 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!