Position Summary:The Optum Health Enterprise Payer Team is responsible for owning, driving, and optimizing Optum Health's payer portfolio to achieve sustainable value-based care relationships. The Senior Product and Benefits Director will play a critical role in developing strategies to successfully position Medicare Advantage products within Optum Health value-based care arrangements including benefit design and planning, sales distribution relationships, identifying best practices, and AEP/OEP/SEP payer performance.
This individual will be expected to:
- Be the subject matter expert for Medicare Advantage benefits and products including product management, product definition, risk identification, standard benefit models, and financial and regulatory impacts
- Own the Optum Health strategic analysis of Medicare Advantage benefit design and planning
- Provide quantitative and qualitative interpretation of AEP payer performance to help advance Optum Health goals
- Understand CMS required deadlines and quality requirements for Medicare Advantage products and programs
- Understand the scope and strategy for bid submission, including defining standard benefit models and alignment to product strategy
- Foster relationships with cross-functional partners to solve critical business initiatives
- Proactively identify problems and develop recommended solutions
This individual will need to be able to function in a diverse environment with varying level stakeholders across internal and external stakeholder groups, abstract and fluid environments, and simultaneous deadlines. The position requires an ability to comprehend Medicare Advantage, local markets' strategies while demonstrating awareness of broader systems across the enterprise, both strategically and tactically. Organizational agility will be required - building meaningful relationships and facilitating decision-making to continue achieving Optum Health's value-based care agenda.
Primary Responsibilities:- Lead end to end benefit strategy for all payers across Medicare Advantage plans
- Create solid relationships with payer product teams to align membership strategies with enterprise financial performance targets
- Analyze benefit performance/ROI and develop investment recommendations
- Partner with Health Care Economics and Actuarial teams to ensure MACVAT data is completed and correct prior to socialization with key regional partners
- Conduct in-depth analysis and strategic summary of AEP results
- Identify key benefit battleground states and areas of greatest risk and opportunity along with key market insights
- Ensure cross functional collaboration with finance and HCE to quantify benefit decision impact
- Partner with local growth and marketing teams on broker/partnership strategy and execution, to unify capabilities where possible and create a cohesive approach
- Develop and socialize specific AEP strategies with leadership and provide market feedback
- Develop executive materials for overall benefit strategies and approach
- Collaborate with care delivery and Optum at Home to build risk programs that strengthen overall market positioning and advance Optum's value prop to further differentiate for consumers and partners
- Synthesize market, competitor, regulatory, financial, and operational intelligence to inform priorities, decisions, and future innovation opportunities
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 10+ years of experience in healthcare strategy, Medicare, product management, innovation, or consulting
- 5+ years of health plan or Medicare Advantage experience
- Expert knowledge of Medicare Advantage benefits and products including product management, product definition, risk identification, standard benefit models, and financial and regulatory impacts
- Experience with Medicare Advantage bid filings
- Demonstrated ability to achieve high performance by utilizing resources in a matrix environment
- Demonstrated ability to work with and communicate with all levels of the organization
- Proven solid analytical skills
Preferred Qualifications:- Knowledge of Medicare Stars, HEDIS, value-based care models, provider incentives, care gap closure, supplemental data exchange, pharmacy quality, affordability/utilization, and provider engagement operations
- Experience working with Actuarial and Underwriting teams
- Proven ability to achieve superior results in a performance-oriented environment
- Proven ability to work with all levels of management across all functions and business partners
- Demonstrated problem solving, analysis, and resolution at strategic and functional levels
- Demonstrated ability to manage competing priorities and a rapidly changing business environment
- Demonstrated excellent written and verbal communication skills
- Willingness to travel up to 20%
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 - $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
