Job Description: Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: This position provides oversight and leads multiple cross-organizational teams through the product development process within government programs lines of business, including Medicare individual plans, employer group plans, and special needs populations. Key areas of focus include management of market research, competitive analysis, strategic product positioning, and benefit design and pricing. This position is also responsible for coordination and execution of the Medicare product development process from concept through implementation, and ensuring the process and products are in compliance with State and Federal regulations.
Lead development of Medicare plans, including the market research, competitive analysis, and product and compliance requirements, and the data and research to support decisions. Evaluate expansion opportunities, oversee and execute the annual bid process, and perform competitive analysis. Work closely with actuarial and other departments in the design and analysis of products, relying on industry research, historical product performance, and marketplace trends.
Lead and facilitate the Medicare product development process to achieve product and line of business goals, and effectively promote senior products and services. Develop and execute the product work plan. Monitor activities and progress, and analyze results to measure effectiveness.
Oversee and execute the annual bid process ensuring timeliness and accuracy, and maintain plan design documentation and job aides. Manage projects including the implementation of new benefits, benefit changes, service area expansion, and plan consolidation.
Lead and facilitate cross-functional teams to meet overall stakeholder expectations and plan's objectives. Responsible for planning and scheduling project goals, milestones, deliverables, and reporting progress as well as risks to management stakeholders.
Develop and maintain subject matter expertise related to Medicare Advantage service area expansions, notice of intent to apply, bid and implementation planning. Provide consultation to all internal areas with regard to product designs and capabilities.
Prepare and deliver presentations to management, members, brokers and external audiences to solicit support in the development, implementation or continued monitoring of products with regard to administration, enrollment, claims, benefit utilization, and market acceptance.
Maintain knowledge of state and national government programs, health insurance markets, the reform environment and product trends. Provide leadership and guidance in analyzing sales areas and opportunities in collaboration with the Government Program Sales and Marketing and Communications teams to ensure success.
Responsible for oversight, management, development, implementation, and communication of department programs.
Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed.
Coordinate business activities by maintaining collaborative partnerships with key departments.
Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
Actively participate as a key team member in Manager/Supervisor meetings.
Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Minimum of 5 years' experience working with Medicare & Medicaid programs, preferably within a Health Plan setting. A minimum of 3 years of people management experience is preferred. Project management experience in strategic planning and product development required.
Education, Certificates, Licenses: Bachelor's degree in Business, Marketing, Health Administration, or equivalent work experience required.
Knowledge: Excellent written and oral presentation skills are required. Effective in fostering communication and collaboration with a variety of people, including different departments within the organization. Strong math skills, including percentages, ratios, statistics, graphing and spreadsheets. Requires the ability to define and prioritize work without direct supervision. Advanced knowledge of Medicare within the health insurance industry. Requires excellent project management skills including time management, coordination with other staff, and resource usage. Requires strong analytical and organizational skills. Intermediate Computer Skills in a Windows Operating System. Proficient in Microsoft Office Applications. Knowledge of Federal & relevant State legislative & regulatory requirements. Knowledge of health payer operations and customer operations. Strategic planning and business plan development experience. Proficient in Microsoft Office software (Access, Excel, Outlook, PowerPoint, and Word). Solid organizational and time management skills. Ability to work as part of a team with strong relationship building skills.
Building a Successful Team
Aligning Performance for Success
Driving for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.