Vice President SHS Individual Business and Segment Strategy
Emergent Holdings

SUMMARY:

The Vice President SHS Individual Business and Segment Strategy will lead Individual Medicare programs with a focus on growth and the SHS strategy function to further the Senior Health Services Blue for Life strategy. Reporting to the EVP, Senior Health Services,the VP Individual Business and Segment Strategy will be accountable for the growth of the Individual Medicare business lines (including Medicare Advantage and Medicare Supplement), by leading product and pricing, working closely with Sales and Marketing (RSMU) to drive go to market strategies and growth tactics, and driving overall performance of the Individual Medicare business. This role also leads the maintenance and oversight of the divisional Blue for Life strategy and multi-year planning activities to support the business segment in achieving multi-year business goals.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

Individual Medicare Product and Distribution

• Accountable for Individual Medical Medicare Advantage, Medicare Supplement, and Individual PDP product portfolio, including bid (pricing) strategy and approval processes; works closely with functional leaders influencing the Medicare Advantage bid / pricing process to develop lever commitments and iterate (as required) to submit a successful bid / pricing to DIFS
• Understands Individual Medicare Advantage, Medicare Supplement, and Individual PDP competitive landscape; ensures business plans and products drive growth despite aggressive competitors in the market
• Works directly with actuary and finance teams to interpret and inform business assumptions driving Individual Medicare financial results and performance of the business; supports executive messaging through the lens of the Individual Medicare, Medicare Supplement and Individual PDP P&L and the strategic plan
• Collaborates with VP Group Medicare on product design based on key account needs
• Defines growth priorities and approves activities and initiatives for the Individual Medicare business. Efforts include working closely with Sales and Marketing (RSMU) to deliver on growth targets and initiatives, evolving and creating new distribution strategies, and monitoring financial performance (AEP, In-Year, Age-In, etc.); leads mitigation strategies to augment efforts or deploy more targeted campaigns and efforts (as necessary)
• Oversees RSMU defined go to market distribution strategy to achieve established growth targets, and develop distribution models that will optimize growth; leads identification of gaps and drive mitigation strategies (as necessary)

Competitive Analytics & Market Intelligence

• Leads competitive analysis function for the Individual Medicare market, including competitive analytics that feed into the overall business segment strategy; establishes informed growth targets based upon competitive product positioning, progress of go-to-market capabilities, and other market factors
• Conducts market research broadly for the SHS segment and works with business partners to interpret market / regulatory implications for the business; develops recommendations to protect and grow the business
• Tracks performance against growth targets; leads the development of mitigation plans to ensure the Individual Medicare business is achieving or exceeding market growth rates; protects and expands market share for the Individual Medicare business
• Accountable for the Individual Medicare budget, optimizing investments to achieve growth rates; continuously compares segment performance against benchmarks, working across the enterprise to optimize return on investments
• Owns establishment of Individual membership targets; responsible for defining annual growth plan, including translation to AIP, for the division in partnership with key business line leads
• Oversees coordination interpretation of business implications due to regulatory changes working closely with GRAD, Compliance, RIDGG and other enterprise partners to interpret & assess guidance

SHS Strategy & Special Projects

• Accountable for stewarding segment Blue for Life strategy to drive growth and transformation for the business ensuring that strategic plans across key levers are robust and sufficient to drive multi-year business objectives and aspirations
• Leads annual planning activities integrating strategy and Individual Medicare bid pricing as lead into capital planning process; works with teams to define multi-year initiatives and establish annual portfolio budget and transitions approved annual plans to SHS Performance Office for execution
• Works with EM and BCBSM to capitalize on enterprise investments, strategy, actuarial, and public policy team efforts to understand the evolving Medicare marketplace, including the industry trends, competitive landscape and regulatory changes
• Drives communication of the divisional strategy and performance objectives across the organization; ensures peer level leaders across the organization have strong understanding of divisional goals, including translation of functional specific outcomes required to meet plan commitments
• Leads the bi-annual Competitive Gap evaluation and update process as a key input into the Blue for Life strategy and the segment capital plan; monitors progress against multi-year competitive gap closure to ensure segment strategy is viable and working
• Identifies gaps between segment strategy, Competitive Gap progress, and segment performance including initiatives under performance office oversight; works with EVP, Senior Health Services to develop, distribute, and monitor mitigation plans across the business segment.

Supervisory: Directly manages exempt and non-exempt staff. Carries out responsibilities in accordance with company policies and applicable laws. Responsibilities include interviewing, selecting and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints; and resolving problems.

Performs other related duties which may not be specifically listed in the position description, but which are within the general occupational series and responsibility level typically associated with the employee's class of work.

QUALIFICATIONS:

EDUCATION

Bachelor's degree in marketing, business or a related field is required. Master's in healthcare or business administration preferred.

EXPERIENCE

Ten years of progressively more responsible experience driving large scale transformation in a healthcare environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Experience in a top tier management consulting firm. Five years of progressively increasing executive responsibilities with demonstrated leadership abilities.

SKILLS, KNOWLEDGE, AND ABILITIES:

• Understanding of actuarial principles and practices.
• Ability to apply the principles of logical thinking to define problems, collect data, establish facts and draw conclusions.
• Demonstrated sales knowledge with exceptional growth figures along with a reputation for strong business relationship building.
• Extensive knowledge of key legislative issues that impact Medicare business.
• Extensive knowledge of managed health care industry.
• Extensive knowledge of laws, regulations, and compliance requirements related to Medicare and associated insurance coverage.
• Demonstrated technical knowledge of insurance administration and claims management.
• Strong strategic planning, program development, project management, and staff development skills.
• Ability to manage and collaborate in matrix model organization.
• Excellent analytical, organizational and problem-solving skills, and senior level skills in managing ambiguous situations and issues.
• Ability to negotiate and establish a personal rapport with opposing parties, and to resolve conflicts in a professional manner.
• Thorough knowledge with budget preparation and financial management.
• Ability to develop and implement effective and efficient recommendations.
• Excellent verbal and written communication skills.
• Demonstrated drive, determination, and persistence to achieve annual revenue targets. Seasoned management skills to motivate and inspire optimum performance.
• Presentation skills and confidence to present company and product in one-on-one settings or to large gatherings.
• A commitment to total customer satisfaction.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Frequently required to travel and attend outside meetings with some overnight stays.

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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