VP Insurance Product Design & Implementation

Highmark Health is seeking a VP Insurance Product Design & Implementation who will be accountable for the design, delivery, and administration of insurance products in the Commercial and Government segments. This role involves cross-functional collaboration to ensure timely and budget-compliant delivery of products while focusing on customer needs and regulatory compliance.

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

Requirements:

• 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
• 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