Product Dev Consultant I

2 weeks ago

Southfield, Michigan, United States Emergent Holdings Full time
Job Description

SUMMARY:

This position is responsible for the development of Medicare Advantage product strategy and benefit plan designs. The Product Development Consultant understands Original Medicare and Medicare Advantage plans and surveys competitive and customer preference data to synthesize product design and placement strategies.

RESPONSIBILITIES/TASKS:

Product Strategy
  • Develops product concepts and strategies for Medicare Advantage Individual and Group segments. Solicit input on market needs from business partners across the organization, sales and agents and customers.
  • Works with market researchers to evaluate and test market interest. Monitor industry and competitive product research, identify trends and patterns, and recommend new or enhanced product concepts. Assesses competitive opportunities and incorporate into plan designs.
  • Prepares concept white papers and presentation materials.
  • Works effectively with cross functional teams from the business segment, HCV, corporate strategy, actuary, finance, operations, information technology, provider reimbursement and others during the development of product strategies and product designs.
  • Works with various business units, including Corporate Actuary, Information Services, Michigan and National Sales, Reimbursement Policy and appropriate Visiant client teams to ensure that products are properly balance the needs of multiple constituents.
  • May conduct original market and competitive research on key product elements, features and capabilities.
  • Contributes to the overall annual product portfolio roadmap planning process.
  • Plans, designs and develops new products and business opportunities from conceptual design to board approval. Works on the implementation of new products. Conduct primary and secondary research regarding competitor's strategies, market opportunities, and product trends.
  • Identifies customer insights that drive behavior change.
  • Analyzes market opportunities based on factors such as CMS reimbursement, demographic trends, network capabilities, and product uptake/saturation.
Product Design
  • Develops written market requirements for new and enhanced products. Refines these into detailed product requirements defining specifics of benefit plan designs and system support capabilities in sufficient detail to successfully hand off to product implementation teams.
  • Seeks out early input from product implementation, operations, information technology teams and others to assess potential system and operational impacts and incorporate feedback into plan designs.
  • Works effectively with cross functional teams from the business segment, HCV, corporate strategy, actuary, finance, operations, information technology, provider reimbursement and others, including relevant Visiant client teams during the development of product strategies and product designs.
  • Takes ownership for specific products, developing and disseminating an understanding of the product's strengths and weaknesses in the marketplace. Develops action plans for improving product performance and develops the product's roadmap.
  • Organizes, maintains and disseminates product documentation including the Product Continuum, design summaries and pricing data.
Pricing, Bid Development and Bid Submission
  • Participates in the creation of project plans for Bid Pricing and Assumptions development and coordination and bid submission.
  • Supports development and submission of PBPs (Plan Benefit Designs) for all products and regions for all Medicare Advantage members. Supports desk review.
  • Adheres to timelines as documented in project plans.
  • Schedules, conducts and documents workgroup meetings as required. Organizes and disseminates documents and materials. Provides Status reports and participate in the Medicare Advantage Command Center meetings.
  • Reviews PBPs (Plan Benefit Packages) for all products and regions for all Medicare Advantage members.
  • Supports CMS bid external audit teams and internal operational areas during the annual bid approval process to ensure that all PBP data entry changes recommended by CMS audit teams accurately depict BCBSM claims processing & plan designs in order to achieve final CMS approval for all EGWP and Individual MA-PD and PDP plans.
Product Implementation
  • Supports implementation of product and benefit changes and clarifications across the enterprise to ensure successful construction and launch of the product and collateral materials
  • Supports creation and review of communication materials and configuration of tools to support enrollment, claims and sales functions.
Product Support
  • Interfaces with various departments, senior management and individuals external to Blue Cross Blue Shield of Michigan providing value and support for continuous improvement.
  • Supports benefit clarification and benefit validation activities across all systems and materials.
Special Initiatives
  • Develops business cases for initiatives.
  • Supports development of detailed plans and schedules, identifying goals, objectives, risks and resource allocation.
General
  • Adheres to company and department standard practices and is vigilant with compliance and privacy practices
  • Implements personal practices that ensure a level of attention to detail needed to avoid mistakes that can expose the company to CMS audit or non-compliance citations.
  • Monitors departmental mailbox and respond to product and benefit questions from throughout the company.
  • Participates in refinement of the overall product strategy, design and pricing effort as necessary to react to changing organizational and competitive environments.
  • Represents leadership staff at meetings in their absence.
  • Coaches and mentors team members.
  • Provides feedback on team performance.
  • Ensures that expectations are developed, controlled, and executed in a timely manner.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in business or health related field. Combinations of relevant education, certifications, and experience may be considered in lieu of a degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Seven years of relevant business experience. Five years of experience in Medicare products is required.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Ability to work effectively in a team environment.
  • Strong organizational, planning, analytical, presentation and communication skills.
  • Ability to lead and coordinate work groups.
  • Ability to present solutions and ideas for unique challenges.
  • Leadership and/or analytical experience with data, systems, and operations.
  • Ability to work with minimal supervision to analyze complex problems. Utilizes a variety of resources to find information and synthesize solutions.
  • Ability to interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to Product during the year and for impact to Product Development and Benefit Design.
  • Deep knowledge of claim coding, submission and adjudication concepts and processes.
  • Deep knowledge of BCBSA programs such as BlueCard and Worldwide.
  • Deep knowledge of BCBSA licensing and performance standard requirements.
  • Deep knowledge of CMS guidance regarding product and benefit design and administration.
  • Deep knowledge of Original Medicare rules and benefits.
  • Knowledge of all product/benefit information used in MA member communications, sales, marketing, training, system configuration & CMS attestations.
  • Knowledge of Original Medicare and MA regulations (specifically Medicare benefit and cost sharing knowledge) is required.
  • Understanding of Medicare Part-D benefits.
  • Knowledge of CMS rules and guidance regarding MA product characteristics and administration.
  • Has awareness of and considers system and operational capabilities and constraints when proposing benefit changes.
  • Awareness of all product/benefit information used in MA member communications, sales, marketing, training, system configuration & CMS attestations.
  • Awareness of all product/benefit information used in MA member communications, sales, marketing, training, system configuration & CMS attestations.
  • Awareness of Original Medicare and MA regulations (specifically Medicare benefit and cost sharing knowledge) required.
  • Organizational, planning, analytical, presentation and communication skills.
  • Analytical experience with data, systems, and operations.
  • Ability to work with limited supervision to analyze complex problems. Utilizes a variety of resources to find information and synthesize solutions.
WORKING CONDITIONS:

Work is performed mainly in an office environment with minimal hazards. Ability to work extended hours as needed. Travel may be required.

PAY RANGE:

"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $79,300 and $132,800."

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

About the Team

COBX Co

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