Product Planning Analyst - Medicare Advantage - Full-time / Part-time

The Product Planning Specialist will support all aspects of developing, managing and evaluating the Medicare Advantage product portfolio.  This will include existing Medicare Advantage Products performance, product development and market assessment and implementation of products in expansion markets.  Specific responsibilities include assisting with the analysis and reporting of the Medicare market and competitor landscape. The Specialist will assist in the evaluation of new product ideas including the performance of feasibility assessments and implementation. This position will be critical in the successful submission of the Annual CMS Bid to CMS. This will include detailed project management to ensure that key deliverables are met timely and accurately. Duties will include supporting calendar development and meeting planning, including meetings with actuary, pharmacy, compliance and others, as appropriate. This position will also assist as needed with the preparation and/or review of materials for product filings and applications to the Federal or State Government. This position will support Benefit Adjudication Committee (BAC) meetings and actions including working closely with claims, enrollment, billing and other operational areas to ensure that all divisions of the organization have the appropriate information to configure all operating systems to meet the needs of the Medicare Advantage Product offerings. The Specialist will also work directly with Sales and Marketing to conduct thorough review of all sales and marketing and member materials to ensure that all benefits are displayed and described accurately and in accordance with CMS bid filings and regulations.

Job Description

Assist in annual filing with the Centers for Medicare and Medicaid Services for upcoming plan benefits offering

• Serve as HPMS “super user” for the dept.
  
• Assist with project management of the bid submission process
• Assist with identification of all requirements for the bid and gathering of documents
• Assist with issue development and analysis
• Assist with communicating benefit changes and implementation of changes for upcoming year

Assist with Product Strategy and Product Development

• Market data and competitor information for new product assessments, business case development (market feasibility, competitor offerings, strategic rationale, financial return)
  

Support regular competitor and market analysis as needed, including:

• Data gathering and analysis of provider networks to identify strengths and weaknesses
  
• Assessment of benefit offerings and premiums
• Assessment of enrollment trends and product penetration reports by specific geographic areas  

Benefit Adjudication Committee 

• The Product Specialist will assist with management of the Benefit Adjudication Committee (BAC) and convene a group of subject matter experts from operational areas to ensure the appropriate configuration of plan rules, including benefits, premiums, authorization requirements, etc. 
  
• The Specialist will assist with development, maintenance, and distribution of a project plan related to new benefit/product offerings to all applicable operational areas in advance of the upcoming plan year.

Document Reviews:

• Working in collaboration with Sales, Marketing and other areas that create documents, the Product Specialist will manage the intake and review of CMS required materials such as Annual Notice of Change (ANOC), Evidence of Coverage (EOC), and Summary of Benefits (SOB), as well as other non-regulatory documents to ensure accurate description of plan benefits and cost sharing.
  
• The Product Specialist will serve as a single point of contact for all documents that require Product team review, and will coordinate timely reviews with appropriate members of the Product team, and help address issues or questions that come up regarding products, benefits, premiums, etc.
• The Product Specialist should be well versed in federal regulations and marketing guidelines as they pertain to EOC, ANOC and SOB requirements.

Assist with evaluation of the retiree products, non group products and Part D

• Assist in the assessment of product performance.
  

Product Performance Analytics

• Assist in development and reporting of key metrics including key performance indicators, membership, financial performance evaluation of senior products, competitor membership evaluation and other reports as needed.
  

Assistance with development and filing of product applications and associated follow-up material to federal and state government.

• Work with Legal Department to develop and file policy documents for products regulated by the state
  
• Work with Compliance and Marketing departments to develop and file information required by CMS

Product Management functions

• Clarify benefits and product rules for internal staff and departments
  
• Identify product issues and resolve
• Support interdepartmental team meeting to address cross functional product issues – claims, clinical, customer service, etc
• Support vendor relationship management as necessary, including tracking vendor benefit administration issues and working with vendor and internal stakeholders to resolve

Requirements

EDUCATION: (Minimum educations & certifications required)

• Bachelor’s degree required. Masters’ Degree or work towards one preferred; MBA preferred or other Masters’ degree with strong financial background
  

EXPERIENCE:  (Years of experience)

• Minimum 2-3 years relevant experience including:
  
• Strong understanding of the managed care field preferably Medicare Advantage plans a plus
• Strong understanding of Product Management and Product Development a plus
• Experience with Health Plan Management System (HPMS) and CMS PBP software a plus

SKILL REQUIREMENTS: (Include interpersonal skills)

• Strong analytical skills.
  
• Strong skills and prior experience with productivity tools such as Excel, Word, and PowerPoint.
• Good organizational, communication and facilitation skills are required.
• Ability to work cross functionally as well as ability to work cooperatively as a team member.
• Strong project and time management skills.
• Independent thinker.
• Must possess maturity and a high degree of professionalism as this role requires interaction with senior leaders.
• Must be able to deal with complexity and uncertainty. 
• Must be a self-starter, think creatively, take responsibility, be extremely resourceful and have a high energy level.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About Us:

Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

At Point32Health, we’re working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R4412

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