VP Insurance Product Design & Implementation - Government Markets (Columbia)

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 product portfolio.

• Actively seeking opportunities to retire underperforming or outdated products in the market and streamline and simplifying the overall portfolio. Working with Sales and Government Markets to determine guardrails around which modifications to standards designs can occur.

• Insurance product performance management. Working with Segment and Market leads, actuary, finance and others, develop targets for product performance and assess performance against membership and financial targets. contracting, etc.). Leveraging detailed analytics, identifying opportunities to improve product performance (e.g., enrollment, medical cost management) and creating solutions to drive greater customer value. Understand and share what worked well and what didn’t work well based on actual market experience and identify opportunities for improving specific product performance.

• Other duties as assigned or requested.

QUALIFICATIONS

Required:

• Bachelor’s Degree in Business Administration or other advanced degree

• 7-10 years of experience in healthcare strategy execution

• 7 years of experience with deep breadth and depth of business knowledge across relevant functions (product, marketing, operations, etc.) in healthcare or similarly regulated product industry

• 5 years in a leadership role, with demonstrated ability to work in a matrixed organizational environment

• Demonstrated program/product delivery, analytic and strategic problem solving skills

Preferred

• Deep healthcare expertise

• Experience managing complex delivery initiatives in the healthcare or insurance industry

• Track record of driving transformational change, leading teams, developing talent, and building relationships

• Experience in Product Management, Design Thinking, and/or other similar processes and methods

SKILLS

• Demonstrated strong comprehensive management, leadership and executive skills.

• Experience analyzing and applying a broad organizational and business perspective to identify and maintain focus on key drivers of organizational performance to maintain product performance.

• Thorough knowledge of insurance, healthcare, insurance administration, marketing, business planning, financial management, reimbursement, and operations in health care markets.

• Strong understanding of market trends/needs, business requirements and balance them successfully.

• Ability to directly and successfully lead, mentor and develop a talented team of high-performing individuals in a fast-paced environment.

• External market orientation.

Language (Other than English):

• None

Travel Requirement:

• 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office- or Remote-based

Physical work site required

• No

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum

$185,000.00

Pay Range Maximum

$335,000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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