Product Development Analyst II

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Lansing, MI*

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <br />The Product Development Analyst is responsible for the creation of Medicare Advantage Plan Benefit Packages (PBPs) that define MA products that are filed with Centers for Medicare and Medicaid Services (CMS) as part of the annual MA bid. The Analyst uses CMS software to enter and refine the PBPs. The Analyst participates in and supports the product strategy and development process. The Analyst supports the annual implementation of the products as defined in the bid.&nbsp;&nbsp;<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed mainly in an office environment with minimal hazards. Ability to work extended hours as needed. May be exposed to temperatures that may be cooler than a normal office setting. Travel may be required.</p>
Responsibilities: <br /> <p><strong>Pricing, Bid Development, and Bid Submission:</strong></p> <ul> <li>Develops and submits PBPs (Plan Benefit Packages) for all products and regions for all Medicare Advantage members.</li> <li>Supports the creation and execution of project plans for bid pricing and assumptions development and coordination.&nbsp;</li> <li>Creates, monitors, and executes project plans for PBP (Plan Benefit Designs) development and submission for all products.&nbsp;</li> <li>Serves as Bid Subject Matter Expert during PBP entry and Bid Audit.</li> <li>Works closely with CMS bid external audit teams and internal operational areas during the annual bid approval process to ensure that all PBP data entry changes recommended by CMS audit teams accurately depict BCBSM claims processing &amp; plan designs in order to achieve final CMS approval for all EGWP and Individual MA-PD and PDP plans.</li> <li>Applies any recommended changes within the PBP tool, ensure that plans error-free, in &ldquo;ready for upload&rdquo; status, and transfer files to actuarial services for upload to HPMS within a limited amount of time (i.e. 24 hours) as determined by CMS auditors.</li> </ul> <br /> <p><strong>Product Implementation:</strong></p> <ul> <li>Drives implementation of product and benefit changes and clarifications across the enterprise to ensure successful construction and launch of the product and collateral materials.</li> <li>Provides Subject Matter Expert<strong><em>&nbsp;</em></strong>support for the creation and review of communication materials and configuration of tools to support enrollment, claims, and sales functions.</li> <li>Supports and participates in the creation of plans for Product Development work and manpower requirements to support annual product implementations.</li> </ul> <br /> <p><strong>Product Support:</strong></p> <ul> <li>Interfaces with various departments, senior management, and individuals external to Blue Cross Blue Shield of Michigan providing value and support for continuous improvement.</li> <li>Supports benefit clarification and benefit validation activities across all systems and materials.</li> </ul> <br /> <p><strong>Product Strategy</strong></p> <ul> <li>Collaborates with cross-functional teams from the business segment, HCV, corporate strategy, actuarial, finance, operations, information technology, provider reimbursement, and others during the development of product strategies and product designs.</li> <li>Supports the development of product concepts and strategies for Medicare Advantage Individual and Group segments. Solicits input on market needs from business partners across the organization, sales teams, agents, and customers. Works with market researchers to evaluate and test market interest.</li> <li>Monitors industry and competitive product research, identify trends and patterns, and recommends new or enhanced product concepts.</li> <li>Supports analysis of market opportunities based on factors such as CMS reimbursement, demographic trends, network capabilities, and product uptake/saturation.</li> </ul> <br /> <p><strong>Product Design:</strong></p> <ul> <li>Interprets CMS communications memos, guidance, Advanced Call Letter, and Final Call Letter for impacts to Product during the year and for impact to Product Development and Benefit Design.</li> <li>Supports development of written market requirements for new and enhanced products. Refines these into detailed product requirements defining specifics of benefit plan designs and system support capabilities in sufficient detail to successfully hand off to product implementation teams.</li> <li>Actively seeks out early input from product implementation, operations, information technology teams, and others to assess potential system and operational impacts and incorporates feedback into plan designs.</li> <li>Supports ongoing research, analysis, recommendation, and design for annual MA product development (adding/removing plan options, benefit offerings, etc.) to offer competitive MA products</li> </ul> <br /> <p><strong>General:</strong></p> <ul> <li>Adheres to company and department standard practices and is vigilant with compliance and privacy practices.</li> <li>Implements personal practices that ensure a level of attention to detail needed to avoid mistakes that can expose the company to CMS audit or non-compliance citations.&nbsp;</li> <li>Monitors generic mailbox and respond to product and benefit questions from throughout the company.</li> <li>Participates in refinement of the overall product strategy, design, and pricing effort as necessary to react to changing organizational and competitive environments.&nbsp;&nbsp;&nbsp;</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:&nbsp;&nbsp;</strong></p> <ul> <li>Bachelor&rsquo;s degree in business or health-related field.&nbsp;</li> <li>Combinations of relevant education, certifications, and experience may be considered in lieu of a degree.</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <br /> <p><strong>EXPERIENCE:&nbsp;</strong></p> <ul> <li>Five years of relevant business experience required.&nbsp;</li> <li>Two years of experience with Medicare-related products required.&nbsp;</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:&nbsp;</strong></p> <ul> <li>Has knowledge of CMS rules and guidance regarding MA product characteristics and administration.</li> <li>Has knowledge of and considers system and operational capabilities and constraints when proposing benefit changes.&nbsp;</li> <li>Knowledge of all product/benefit&nbsp;information used in MA member communications, sales, marketing, training, system configuration &amp; CMS attestations.</li> <li>Ability to successfully collaborate with multiple operational areas (compliance, communications, sales, marketing, Actuarial services, finance, claims configuration, G&amp;A, network contracting, Part D, care management, etc.).&nbsp;</li> <li>Knowledge of all product/benefit information used in MA member communications, sales, marketing, training, system configuration &amp; CMS attestation.</li> <li>&nbsp;Knowledge of Original Medicare and MA regulations (specifically Medicare benefit and cost-sharing knowledge) required.</li> <li>Knowledge of project management concepts and the ability to organize work into a detailed plan.</li> <li>Ability to work effectively in a team environment.</li> <li>Organizational, planning, analytical, presentation and communication skills.</li> <li>Leadership and/or analytical experience with data, systems, and operations.</li> <li>Ability to work with moderate supervision to analyze complex problems.&nbsp;&nbsp;</li> <li>Utilizes a variety of resources to find information and synthesize solutions.</li> <li>Knowledge of claim coding, submission, and adjudication.</li> <li>Knowledge of CMS guidance regarding product and benefit design and administration.</li> <li>Knowledge of Original Medicare rules and benefits.</li> <li>Understanding of Medicare Part-D benefits.</li> </ul>