Job Description Summary:

This role operates as a strategic resource across the Medicare Advantage (MA) function, bringing analytical depth, competitive intelligence, and cross-functional coordination to advance enterprise Medicare product objectives. This position will address the highest-priority needs of the MA program and strategy across CMS/regulatory, pricing and financial modeling, product, formulary, network, Stars/Quality strategy in addition to broader programmatic execution. The Lead Consultant independently conducts market and performance analysis, develops strategic recommendations, and coordinates across functional partners to ensure cohesive, insight-driven execution. This position collaborates with Compliance, Legal, Actuarial, Clinical, Network, Sales, and Operations teams and serves as a connective resource across the MA function to advance both near-term deliverables and longer-term strategic initiatives.

Responsibilities include but are not limited to:

• Lead benefit design decisions across core and supplemental benefit categories, balancing member value, competitive positioning, and margin targets. Reviews competitive intelligence, translate population health insights and utilization data into benefit configurations that differentiate the MA EGWP offering. Partner with actuarial to review benefit cost assumptions against enrollment and risk score scenarios. Drive strategic framing of pricing decisions driving financial modeling to support product decisions.
• Ownership of product roadmap towards CMS bid cycles, other regulatory contract requirements and internal governance timelines. Supports synthesis of regulatory guidance, sub-regulatory memos, and policy developments, recommending strategic implications and product strategy adjustments for team consideration.
• Supports go-to-market strategy support and Plan engagement coordination across the MA function. Develops strategic materials and analytical frameworks to support compliant member-facing and broker-facing program execution in partnership with Sales and Field Services. Coordinates with Plan partners on engagement activities, distribution strategy, and training support. Monitors go-to-market performance indicators and recommends strategic adjustments to improve market penetration, member acquisition, and retention outcomes.
• Supports broader MA program strategy including Part D formulary strategy, network strategy and Stars/Quality strategy with cross functional partners.
• Serves as a connective resource across the MA organization, coordinating with functional leaders, Plan partners, and enterprise stakeholders to advance cross-cutting priorities. Represents the Medicare product function in working groups, advisory forums, and stakeholder discussions, bringing analytical perspectives and strategic context. Builds and maintains effective relationships across the broader BCBSA Medicare ecosystem to support integrated, enterprise-aligned program execution.

The posting range for this position is:

129,959.06 - 175,749.89

Required Education, Certifications and Experience:

Education:

• Required BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience

Experience:

• Required 7+ Years Experience in healthcare product development, Medicare product management, or health plan operations, with a track record of independent execution and cross-functional coordination.

Knowledge Skills and Abilities*:

• Proficient knowledge of Medicare Advantage and Part D benefit design, CMS regulatory requirements, and the annual bid cycle process (HPMS submissions, benefit package configuration, regulatory review).
• Demonstrated ability to independently execute complex work streams, coordinate across multiple functions, and manage concurrent deliverables in a regulated environment.
• Strong analytical skills with ability to interpret utilization data, competitive benchmarking, and quality/Stars metrics to drive benefit enhancement decisions.
• Strong written, oral communication, and presentation skills; ability to develop clear analytical materials and represent workstream findings to senior stakeholders.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint); familiarity with project management tools and data visualization platforms.
• Effective stakeholder coordination and relationship-building skills with the ability to collaborate across Legal, Compliance, Actuarial, Clinical, and Operations functions.
• Understanding of FEHBP program structure and applicable regulatory requirements as they relate to MA EGWP product design and administration preferred.

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