Sr. Director, Health Plan Product

Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Sr. Director, Health Plan Product

Position Summary:

Responsible for leading the design and strategy of our Medicare Advantage plan offerings, leveraging industry relationships, competitive intelligence, and deep knowledge of market trends. This role is accountable for developing and executing benefit designs that align with organizational objectives, revenue models, and regulatory requirements while ensuring sustained competitiveness in the marketplace. The Senior Director will collaborate cross-functionally with analytics, operations, network, and sales teams to ensure successful plan design and implementation. This role will additionally partner with Compliance, Legal (particularly for new market expansions), as well as Actuarial and Finance teams.

Job Description:

Primary Responsibilities

• Lead the strategic development of Medicare Advantage products, using data-driven insights and competitive market analysis.
• Monitor industry trends, competitor offerings, and regulatory changes to ensure our plans remain market-leading and financially sound.
• Partner with actuarial and finance teams to model plan designs, ensuring alignment with revenue, growth and margin goals.
• Translate complex market and financial data into actionable benefit design strategies.
• Develop annual bid strategies and oversee the plan design process to meet CMS bid submission deadlines.
• Maintain strong relationships with industry stakeholders and regulatory agencies to anticipate and adapt to market shifts.
• Collaborate closely with cross-functional partners, including analytics, network, operations, compliance, and marketing.
• Provide leadership and direction to assigned team members, fostering professional growth and accountability, and a culture of innovation.
• Manage and develop direct reports (e.g., Product Strategist), ensuring effective utilization of staff resources, coaching, and professional development.
• Ensure product designs meet compliance, quality, and member experience objectives.
• Oversee benefit vendor partnerships by leading vendor selection processes, negotiating contract terms, and collaborating with operations teams to ensure performance standards are consistently achieved.
• Drive initiatives to identify, evaluate, and execute expansions into new markets and product offerings.
• Present to diverse internal and external stakeholders on industry developments impacting Medicare Advantage (e.g., provider medical director meetings, board of directors, broker sales events, conference presentations, strategic partnerships, etc.).

Qualifications

• Bachelor’s degree in Business, Finance, Healthcare Administration, or related field (or equivalent experience).
• 15+ years of experience in Medicare Advantage plan design, product strategy, or related health plan leadership roles.
• Minimum 7 years of progressive leadership experience within a health plan or payer organization.
• Proven track record designing competitive health insurance products in large and complex markets.
• Strong understanding of CMS regulations, Medicare Advantage revenue models, and benefit design strategy.
• Exceptional analytical and strategic thinking skills with the ability to translate data into actionable strategies.
• Strong executive presence with excellent communication and relationship management skills.
• Demonstrated experience managing teams/staff, with responsibility for coaching, development, and performance management.

Preferred

• Leadership experience within a large national or regional health plan/payer, including Tier 1 market exposure.
• Experience with both strategic product development and operational plan execution.
• Advanced degree in Business or Healthcare Administration.

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

#Li-Remote

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

$175,300.00-$249,100.00

Benefits of working at Lumeris

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And Much More...

Be part of a team that is changing healthcare!

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris And Its Partners Are Committed To Protecting Our High-Risk Members & Prospects When Conducting Business In-Person. All Personnel Who Interact With At-Risk Members Or Prospects Are Required To Have Completed, At A Minimum, The Initial Series Of An Approved Covid-19 Vaccine. If This Role Has Been Identified As Member-Facing, Proof Of Vaccination Will Be Required As A Condition Of Employment.

Disclaimer:

• The Job Description Describes The General Nature And Level Of Work Being Performed By People Assigned To This Job And Is Not Intended To Be An Exhaustive List Of All Responsibilities, Duties And Skills Required. The Physical Activities, Demands And Working Conditions Represent Those An Employee Encounters While Performing The Essential Functions Of This Job. Reasonable Accommodations May Be Made To Enable Individual With Disabilities To Perform The Essential Job Duties And Responsibilities.

Lumeris Is An Eeo/Aa Employer M/F/V/D.