VP Insurance Product Design & Implementation - Government Markets

Company :

Highmark Health

Job Description :

JOB SUMMARY

The Vice President, Insurance Product Strategy, Design & Implementation – Government Markets is an executive leader accountable for defining and executing the end-to-end product strategy, design, and delivery of a multi-billion-dollar portfolio spanning Medicare Advantage, ACA Marketplace, and Medicaid products. This role drives the multi-year product roadmap, overseeing benefit design, regulatory bid and filing strategy, and cross-functional implementation to ensure timely, compliant, and high-quality product launches in a highly regulated environment. With full accountability for product performance, this leader partners across actuarial, clinical, network, operations, and market leadership teams to optimize growth, profitability, Stars/HEDIS outcomes, and member experience, while advancing product innovation, portfolio simplification, and capability modernization. The ideal candidate brings deep expertise in government programs, including CMS and state regulatory frameworks, and a proven ability to translate complex policy, market dynamics, and customer insights into scalable, market-leading products that drive sustainable membership growth and competitive differentiation.

In the delivery of the product strategy led by the VP, Product Strategy, Design, & Experience this role focuses on the customer, their goals, needs and pain points, and partners with senior leaders in our segments, markets, and leaders of functional areas across the enterprise to ensure that our insurance product portfolio meets the evolving needs of our customers within a highly regulated and competitive marketplace and aligns to our enterprise strategies. 

A successful incumbent will master cross-functional coordination, prioritization, decision making, and delivery of strategic priorities while ensuring that our complex product portfolio is effectively maintained, simplified, and enhanced.  Key skills and experience for the role include product development, implementation; performance analysis and reporting; business planning and tradeoff decision making; customer insights; healthcare compliance and regulatory environment; and internal/external service delivery partner interactions.

ESSENTIAL RESPONSIBILITIES

• Insurance product design. Working across functions, responsible for the delivery of the multi-year insurance product strategy integrating insurance product design and experience (benefits, networks, medical management, reimbursement design, ancillary benefits, digital tools, customer service features, etc.). Our product design will be aligned with the solutions and capabilities developed through our Living Health strategy, and inform the product capability investments to support the ongoing simplification and increased customer engagement with our insurance products.
• Insurance product delivery.  Prepares detailed design specifications and coordinates/leads insurance product portfolio implementations, including new and enhanced products/features, through complex, cross-functional strategic initiatives.  Works with benefit coding, network coding, relevant claims and reimbursement systems, etc., supporting effective implementation of new products by ensuring timely and cost-effective implementation and the fidelity of product implementations to the strategic intent of the product.  Provides subject matter expertise, including regulatory and operational insights, during strategy and design process for new and enhanced solutions, products and benefits.  Partners with enGen and other functional business areas to identify opportunities to improve product delivery tools and capabilities.

• Insurance product administration.   Working collaboratively with various cross-functional stakeholders in the organization, administer broad and complex portfolio of market differentiated and compliant insurance products across markets and segments. This administration includes:

  • Timely and accurate applications and filings to federal and state regulators.
  • Managing insurance product compliance with federal and state mandates.
  • Drafting, updating and filing insurance product contracts with regulatory agencies.
  • Benefit and collateral quality control
  • Product-related sales support, including RFP support, internal/external sales training, etc.
  • Lead structured product portfolio reviews to support updates on plans, delivery, and the launch of the produc…