EmblemHealth

Director, Employer Segments (Healthcare Product Operations)

EmblemHealth • $150K — $180K *
New York, NY 10025In-Person
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in Business, Health Administration, Public Health, Finance or related field required
  • Master's degree (MBA, MHA, MPH) strongly preferred
  • 10 - 12+ years of progressive experience in health insurance product management
  • 5+ years' experience at a Director or senior leadership level
  • Deep ASO/self-funded product expertise is required
  • Proven experience leading a team of product professionals
  • Strong cross-functional partnership skills with a record of collaboration in health plans
  • Regulatory knowledge of New York market requirements

Responsibilities

  • Drive product delivery and implementation of the employer segment strategy across various product lines
  • Lead ASO product management and operations with deep subject matter expertise
  • Set medical benefit templates, plan structures and ensure regulatory compliance for employer products
  • Develop and manage a high-performing product team, setting clear expectations and conducting performance reviews
  • Partner with leadership to translate market priorities into product direction and support RFP responses
  • Identify growth opportunities to deepen product penetration within the existing employer book
  • Coordinate cross-functionally to move products from design to launch-ready state, serving as the primary decision-maker

Benefits

  • Opportunities for professional development and growth
  • Collaborative work environment with cross-functional teams
  • Access to industry insights and regulatory expertise
  • Ability to shape and influence product strategy
  • Opportunity to impact the organization’s market positioning and competitiveness
Full Job Description
Summary of Position
  • Responsible for translating, implementing and operationalizing the product strategy across all employer-facing lines of business: Large Group Fully Insured (LG FI), Small Group Fully Insured (SG FI), ASO/Self-Insured, Level Funded in addition to joint / shared administration arrangements and Ancillary products.
  • Support the organization's strategy to grow FI, Self-Funded and Level Funded membership, modernize its administration platform, compete for joint-administration accounts, and launch innovative large group product capabilities the market expects.
  • Maintain and enhance the existing employer book, redesign the administration model for scalability and compliance, drive joint administration implementation with TPA and co-carrier partners, support the build and implementation of new ASO capabilities and lead the FI and ancillary product platforms.
  • Responsible for translating the department's Employer Segment's business priorities into market-ready, financially sound and operationally executable product designs and for holding the team accountable for on-time delivery, regulatory readiness and product quality across the full employer book.
  • Partner with sales leadership in client facing presentations serving as the product subject matter expert who fields questions and articulates technical and operational details in real time.


Principal Accountabilities
  • Drive product delivery and implementation of the employer segment strategy across LG FI, SG FI, ASO/Self-Insured, Level Funded and Ancillary products. Define the multi-year product roadmap aligned to GM's P&L priorities, growth targets and competitive positioning.
  • Lead ASO product management and operations with deep subject matter expertise in self-funded employee benefits. Define ASO standard vs. non-standard product guardrails and value proposition and shape the service model in partnership with the areas that own its components (admin services, reporting, stop loss, care management).
  • Responsible for benefit design standards and regulatory filing strategy for the employer book. Set medical benefit templates, plan structures and network configurations for LG FI and SG FI. Ensure all employer products are rate-able, DFS compliant, and aligned with actuarial pricing assumptions.
  • Lead, develop and hold accountable a team (ASO Products, FI & SG Products, Ancillary). Set clear role expectations, provide coaching and development, conduct performance reviews and build a high-performing product team capable of executing across all employer LOBs.
  • Partner with the GM, Employer Segment and Sales leadership to translate employer market priorities into clear product direction. Support RFP responses, broker strategy and account-level product decisions. Bring product expertise into go-to-market conversations and ensure the Sales team is equipped with competitive, accurate product positioning.
  • Collaborate on employer product growth efforts. Identify opportunities across ASO and LG expansion, SG retention, and ancillary product to deepen product penetration within the existing employer book, driving greater adoption of ancillary lines alongside the core medical plan in partnership with sales and account management.
  • Coordinate cross-functionally across Actuary, Legal, Compliance, IT, Network, Operations, Communications and more to move products from design to launch-ready state. Serve as the primary decision-maker and escalation point for employer product issues. Represent the employer product function in executive forums, and regulatory discussions.


Qualifications

Education, Training, Licenses, Certifications
  • Bachelor's degree in Business, Health Administration, Public Health, Finance or related field required.
  • Master's degree (MBA, MHA, MPH) strongly preferred.


Relevant Work Experience, Knowledge, Skills, and Abilities
  • 10 - 12+ years of progressive experience in health insurance product management. (Required)
  • 5+ years' experience at a Director or senior leadership level. (Required)
  • Deep ASO/self-funded product expertise is required. Candidates must demonstrate hands-on experience designing and managing ASO product platforms, service models, stop-loss structures and employer-specific configurations in a regulated health plan environment. (Required)
  • Fully Insured product experience across Large Group and/or Small Group markets, including benefit design, ACA compliance, DFS filing requirements and community rating rules in New York. (Required)
  • Proven experience leading a team of product professionals. Demonstrated ability to hire, develop and hold accountable a team of Leaders or Senior Managers. (Required)
  • Strong cross-functional partnership skills. Track record of successful collaboration with Actuarial, Sales, Legal, Compliance, Network and Operations functions in a health plan. (Required)
  • Regulatory knowledge of New York market requirements (DFS, ACA, ERISA, NYS DFS rate filing processes). (Required)
  • Ancillary product experience (Dental, Vision, Rx). (Preferred)
  • Exceptional communication skills, both verbal and written. Ability to present product strategy clearly to executive leadership, Sales leadership and external stakeholders. (Required)

About EmblemHealth

EmblemHealth is a non-profit health insurance company based in New York City. It is one of the largest non-profit health insurers in the United States, serving over 3 million people. EmblemHealth offers a range of health insurance plans, including HMO, PPO, and EPO plans, as well as Medicare and Medicaid plans. The company also offers wellness programs and disease management services. EmblemHealth was formed in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). The company has offices in New York City and Albany, New York.
Learn more about EmblemHealth
Size
3,000 employees
Industry
Healthcare
Net Income
-$100 million
Founded
2006
5 Year Trend
-5%
Revenue
$10 billion
NASDAQ
* Ladders Estimates

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