Job Description:
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. The Manager of Product is responsible for development, implementation and ongoing management of a broad portfolio of Large Group Fully Insured (LGFI) products, across four or more states (in addition to possible expansion areas), within the Commercial Market Division Segment, as well as management of direct report(s).This Manager works with numerous Medica functional areas to determine the market need and feasibility for development of new products, enhancements to existing products, and all aspects of regulatory filings at both the state and federal level. The Manager is responsible for overall market success of the products, oversight of policy document development, timely and accurate CMS and state submissions (and meeting of requirements), and benefit structure. The Manager will set, maintain, document and preserve intent of product and plan design. The Manager works closely with segment leadership, sales, operations, compliance, legal, network, finance, pharmacy, underwriting and actuarial, to continuously improve market competitiveness and market position as applicable, communicate and train staff on product details, and ensure proper administration and understanding of product intent. The Manager is subject matter expert on assigned product plan performance, including membership, income, medical loss ratio (MLR) and operating margin, and will work directly with internal leadership on strategies to improve product performance. The incumbent contributes to the strategic planning process for Medica’s Commercial’s product portfolio by identifying, implementing and managing strategic partnerships and external vendors. The Manager collaborates extensively with legal and governmental agencies such as CMS, MN Department of Commerce and regulators in multiple states. Performs other duties as assigned.
Key Accountabilities: Product Strategy and Development (40%)Product Strategy and Project Leadership:
- Leads product strategy and project teams to develop and deliver Large Group Fully Insured (LGFI) product solutions.
- Collaborates with segment leadership and functional leaders to address product-related issues and identify opportunities for improvement.
- Benefit Design and Compliance:
- Acts as a subject matter expert (SME) on LGFI benefits, including pharmacy coverage.
- Interprets federal and state regulatory guidance and ensures compliance in benefit design.
- Researches and implements policies aligned with federal and state laws.
- Continuous Enhancements:
- Analyzes LGFI programs to identify enhancements in benefits, networks, clinical aspects, and formularies.
- Collaborates with finance and actuarial teams to validate findings and recommend improvements.
- Product Knowledge:
- Understands LGFI products and markets.
- Familiar with stop loss insurance, claims platforms, and processes.
- Knowledgeable about ERISA and non-ERISA benefits.
- Competitive Intelligence:
- Ensures benefit designs align with market trends, member needs, and financial goals.
- Manages competitive intelligence gathering for strategic decision-making.
- Product and Project Management (40%)Project Execution and Control:
- Manages project costs, schedule, and scope using established processes and metrics.
- Ensures timely submission and response to contractual reporting requirements from state and federal governments.
- Effective Communication:
- Communicates project status and key metrics to all levels of management.
- Organizes and analyzes data for internal and external stakeholders.
Cross-Functional Leadership:
Leads cross-functional teams to develop new products, programs, tools, and processes.
Prioritizes recommendations related to NCQA measures and consumer demand.
Documentation and Reporting:
- Independently prepares and maintains project documentation.
- Summarizes and analyzes results data for senior management.
- Creative Problem Solving:
- Utilizes business acumen and analytical skills to identify effective solutions for Medica and vendors.
- Build & maintain relationships (10%)Internal Partnerships:
- Develops and maintains partnerships with internal sales and account management teams.
- Representation and Collaboration:
- Represents the segment in product-related workgroups within Medica.
- External Engagement:
- Leads Medica’s participation in external work groups with entities such as ACOs/care systems, state regulators, and brokers.
- Staff Supervision (10%)Internal Partnerships:
- Develops and maintains partnerships with internal sales and account management teams.
- Representation and Collaboration:
- Represents the segment in product-related workgroups within Medica.
- External Engagement:
- Leads Medica’s participation in external work groups with entities such as ACOs/care systems, state regulators, and brokers.
Required Qualifications:- Bachelor's degree in health care, business, or related field 5+ years of work experience beyond degree 3+ years of product experience 1+ years of leadership, management and / or team lead experience
- Manager-level health plan administration, including experience with senior leadership
- Health plan benefit design & implementation
- Monitoring product lifecycles & establishing metrics to measure product successCMS and state compliance and health plan regulatory environment understanding
- Understanding of health plan operations
- Cross-functional team and project management
- Analytical ability in business planning and financial management/acumen
- Strategic thinking
Preferred Qualifications:
Strongly preferring Commercial knowledge / experience This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.The full salary grade for this position is $100,300 - $172,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $100,300 - $150,465. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
