The Qualified Health Plan (QHP) Product Manager leads day-to-day product operations, ensuring both the alignment of business processes with product strategy as well as product compliance with state and federal regulatory requirements. Working under the direction of the Director of QHP Strategy, the Product Manager will oversee the execution of product changes and deliverables, drive on-going process improvements, support the resolution of cross-functional business issues and serve as the primary liaison with BMCHP’s product distribution channels (Massachusetts Health Connector and HSA). As needed, the Product Manager may also support product analytics as well as major initiatives that are critical to QHP product success including the annual Qualified Health Plan recertification process. This position is also responsible for overseeing BMCHP interfaces with federal and state portals, including but not limited to HIOS and SERFF.
KEY FUNCTIONS/RESPONSIBILITIES:
Product Management
- Leads day-to-day product operations, cross-functional issue resolution, and the implementation of QHP-specific process improvements and program changes for BMCHP’s Qualified Health Plan product portfolio.
- Owns comprehensive QHP Annual Calendar and works closely with functional Business Owners to ensure BMCHP meets regulatory deadlines inclusive of reporting (state and federal) and successfully executes against key product deliverables.
- Independently owns and oversees portfolio of QHP projects and initiatives including stakeholder engagement, establishing project scope, on-going project management, internal communications, and status reporting to senior leadership.
- Disseminates key state and federal regulatory updates, identifies potential impacts to BMCHP, and oversees program change implementation (as applicable):
- Partners with internal stakeholders and subject matter experts (SMEs) across BMCHP to assess the end-to-end impact of internal and external program change requests inclusive of reporting, vendor integration, and system configuration.
- Owns the submission of comprehensive change requests for internal/external program changes which are cross-functional / impact multiple business areas, including procuring signoffs and approvals for final requirements for QHP program changes.
- Liaison to IT to ensure successful implementation.
- Chairs QHP Product Operations Team and owns meeting administration including scheduling, setting the weekly agenda, taking minutes, executing meeting follow-up, and archiving meeting materials/artifacts.
- Supports QHP analysis, reporting, and strategic planning efforts.
Distribution Channel Management
- Serves as the primary liaison and contact between QHP distribution channel partners (Health Connector, HSA) and BMCHP supporting on-going contract questions, escalations, and ad hoc inquiries/requests.
- Maintains thorough understanding of contractual and regulatory requirements for BMCHP’s Qualified Health Plan products. Serves as internal resource and subject matter expert on QHP contracts and regulations and manages processes/protocols for ensuring compliance with contractual and regulatory product requirements.
- Owns research and follow-up for ad hoc inquiries and data requests.
- Partners with functional Business Owners to ensure the successful resolution of day-to-day issues and member escalations which may include member eligibility, enrollment, data exchanges (e.g. 834,820 and provider data files), benefits administration, and/or claims processing.
- Plans and coordinates all activities during all phases of the annual QHP Seal of Approval (SoA) process including RFR release and analysis, RFR response development and submission, plan management testing, and Open Enrollment outreach activities.
Regulatory and Compliance
- Manages and maintains oversight of state and federal data exchange portals, including but not limited to the Health Insurance Oversight System (HIOS), System for Electronic Rate and Form Filing (SERFF), The Health Connector ShareFile, and File Transfer Protocol (FTP) sites.
- Manages protocols for monitoring and evaluating regulatory developments related to QHP and Public Exchange programs. Monitors, analyzes, and disseminates QHP policy and regulatory updates communicated by CMS through the bi-weekly CCIIO Issuer Insights to affected business areas.
QUALIFICATIONS:_ _
EDUCATION:__
__
- Bachelor’s Degree in Business Administration, Public Health Administration, Public Policy, or a related field. Candidates who do not meet the educational requirement but possess the appropriate combination of experience and training will be considered.
- Master’s Degree in Business Administration, Public Health, or Public Policy preferred.
EXPERIENCE:_ _
- Five or more years of experience as a product manager (health insurance or experience in regulated insurance product preferred).
- Experience supporting Qualified Health Plans on Public Exchanges, including the Massachusetts Health Connector preferred.
COMPETENCIES, SKILLS, AND ATTRIBUTES:
- Knowledgeable about Qualified Health Plan products/market and Health Care Reform developments and changes.
- Ability to effectively communicate issues, findings, and recommendations both verbally and in writing to all levels of management and external stakeholders and regulatory agencies.
- Ability to build relationships and alliances and successfully interact within all levels of the organization and external stakeholders.
- Strong analytic thinking and ability to execute data analysis and develop compelling performance reports.
- Experience working effectively in a matrix environment to accomplish work through others.
- Highly organized with strong attention to detail.
- Self-directed and resourceful, with an ability to successfully adapt to changing work environments and independently drive forward product changes and improvements.
- Strong verbal and written communication skills.
- Highly proficient with Microsoft Office Suite.
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Ability to travel within Massachusetts
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills
Required Experience