MEDICARE ADVANTAGE AVP

Position Summary

Leads the development, execution, and lifecycle management of Medicare product strategies, including Medicare Advantage (MA), Prescription Drug Plans (PDP), and Special Needs Plans (SNPs). Responsible for designing competitive, compliant, and profitable products aligned with the Center for Medicare and Medicaid Services (CMS) regulations and the organization’s strategic objectives, ensuring growth, membership retention, and market differentiation within the Medicare segment.

Key Responsibilities

• Lead the development, enhancement, and lifecycle management of Medicare products, including Medicare Advantage (MA), Prescription Drug Plans (PDP), and Special Needs Plans (SNPs), ensuring alignment with organizational goals and market opportunities.
• Develop and execute strategic product roadmaps that drive membership growth, retention, profitability, and competitive differentiation within the Medicare market.
• Monitor and interpret CMS regulations, guidance, and industry trends to ensure product compliance and proactively identify opportunities for innovation and market expansion.
• Direct the annual bid development process, benefit design strategies, and pricing recommendations in collaboration with actuarial, finance, compliance, and operations teams.
• Conduct market research, competitive analysis, and member needs assessments to identify emerging opportunities and enhance product offerings.
• Partner with cross-functional teams, including Sales, Marketing, Provider Networks, Clinical Operations, Compliance, and Finance, to ensure successful product implementation and execution.
• Oversee regulatory submissions and product filings, ensuring accuracy, completeness, and timely compliance with CMS requirements and deadlines.
• Establish and monitor key performance indicators (KPIs) related to product performance, membership growth, retention, revenue, and customer satisfaction, implementing corrective actions when necessary.
• Lead, mentor, and develop a high-performing product development team, fostering a culture of accountability, innovation, collaboration, and continuous improvement.
• Serve as a strategic advisor to executive leadership by providing insights, recommendations, and business cases related to Medicare product strategy, market expansion, and long-term growth initiatives.

Work Environment

This position operates in a professional office and hybrid work environment, requiring frequent collaboration with cross-functional teams, senior leadership, and external stakeholders. The role involves extensive use of computer systems, virtual meeting platforms, and analytical tools to support strategic planning, product development, and regulatory compliance activities.

The incumbent will regularly interact with departments such as Actuarial, Finance, Compliance, Sales, Marketing, Clinical Operations, and Provider Network Management, as well as regulatory agencies and external business partners. The position may require participation in meetings outside of regular business hours during critical Medicare bid cycles, product launches, or regulatory submission periods.

Qualifications

Education & Experience

• Master’s Degree in Business Administration, Economics, Healthcare Administration, or related areas. At least six (6) years of experience performing functions in Medicare product and/or market development, working within highly regulated environments and interacting with regulatory agencies. At least three (3) years of experience supervising personnel.

  OR

  Education and Experience: Bachelor’s Degree in Business Administration, Economics, Healthcare Administration, or related areas. At least eight (8) years of experience performing functions in Medicare product and/or market development, working within highly regulated environments and interacting with regulatory agencies. At least five (5) years of experience supervising personnel.

Language Requirements

• Fully bilingual in English and Spanish (written and verbal).

Skills & Competencies

• Extensive knowledge of Medicare Advantage (MA), Prescription Drug Plans (PDP), Special Needs Plans (SNPs), and CMS regulatory requirements.
• Strong strategic thinking and business acumen with the ability to translate market insights into profitable product strategies.
• Proven experience in product development, product lifecycle management, and healthcare market expansion initiatives.
• Advanced analytical and problem-solving skills with the ability to evaluate complex data, identify trends, and make data-driven decisions.
• Strong understanding of Medicare bid development processes, benefit design, competitive positioning, and membership growth strategies.
• Excellent project management skills, with the ability to lead multiple initiatives simultaneously and meet critical regulatory deadlines.
• Demonstrated leadership and people management capabilities, including coaching, mentoring, and developing high-performing teams.
• Exceptional communication, presentation, and stakeholder management skills, with the ability to influence executive leadership and cross-functional teams.
• Strong collaboration and relationship-building skills to effectively work with internal departments, regulatory agencies, consultants, and external partners.
• Experience operating within highly regulated healthcare environments while ensuring compliance with federal and state requirements.
• Financial acumen, including experience evaluating business cases, product profitability, budget management, and return-on-investment analysis.
• Ability to lead organizational change, drive innovation, and identify opportunities for continuous improvement.
• Strong negotiation and decision-making skills with a results-oriented mindset.
• High level of professionalism, integrity, accountability, and commitment to operational excellence.

TPIS is an Equal Opportunity Employer (EEO Employer / Affirmative Action for Females / Disabled / Veterans). We comply with all Federal, State and Local laws regarding nondiscrimination.