Lead Insurance Product Manager – Part D/PDP

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the year-round strategy and execution of Medicare Part D/PDP products.

• Analyze competitive, financial, regulatory, operational, and member insights to propose portfolio actions.

• Formulate recommendations for new or improved benefits, product features, and market strategies.

• Direct annual PDP bid-cycle operations, encompassing benefit design coordination, bid submission preparedness, PBP Section Rx, HPMS, resolution of validations, and cross-functional alignment.

• Manage benchmark, de minimis, rebate reallocation, desk review, and related PDP tasks.

• Address filing queries, validation findings, audit exhibits, and CMS submission challenges.

• Set governance frameworks, decision points, and controls to ensure accurate, timely, and compliant submissions.

• Interpret CMS directives and Medicare Part D policy updates into actionable product requirements and execution strategies.

• Lead feasibility studies across product, regulatory, actuarial, financial, pharmacy, operations, technology, and member experience departments.

• Drive new Part D initiatives, including CMMI demonstrations and emerging pharmacy programs, from conception through execution.

• Manage annual PDP readiness through the AEP and January 1 implementation.

• Oversee member-facing benefit communication, product information, digital tools, training, and operational preparedness.

• Provide PDP support for State Pharmaceutical Assistance Program requests, evaluations, contracting assistance, and implementations.

• Develop standards, controls, and reusable resources for PDP strategies, filings, and readiness.

• Enhance processes leveraging data, lessons learned, and root-cause analysis.

• Serve as a business subject matter expert on automation and product data initiatives.

• Offer functional leadership, coaching, and subject-matter advice without formal people-management authority.

• Facilitate intricate decision-making, communicate evidence-based recommendations, and escalate significant risks.

• Report to the Director of Insurance Product Management and act as the primary CPES lead for PDP product strategy and execution.

⛳️ Requirements

• Bachelor’s degree.

• 5+ years of pertinent experience in healthcare, health plans, Medicare, product management, or a related field, with significant Medicare Part D experience.

• Direct involvement with standalone Prescription Drug Plans and the Medicare Part D product lifecycle.

• Experience in leading Medicare Part D product strategy, bids, filings, benefits implementation, or annual readiness activities.

• Capability to interpret CMS regulatory, contractual, or operational guidelines and translate them into product requirements, decisions, and execution plans.

• Proven track record in leading complex cross-functional projects, processes, or teams with minimal guidance.

• Ability to exercise independent judgment, analyze intricate information, and present clear recommendations and trade-offs to senior management.

• Outstanding written, verbal, facilitation, and presentation abilities.

• Willingness to work extended hours and occasional weekends during critical CMS, bid, and implementation periods.

• Extensive hands-on experience with PDP bid submissions, PBP Section Rx, HPMS, audit exhibits, benchmarks, de minimis, rebate reallocations, or desk review activities.

• Knowledge of LIS, SPAP, formulary coordination, Part D member materials, and AEP readiness.

• Familiarity with competitive intelligence, CMMI demonstrations, or the implementation of new CMS pharmacy initiatives.

• Experience in developing business requirements for automation, process enhancements, product data, or benefit-authoring tools.

• Background in creating governance, quality controls, metrics, or reusable operating mechanisms for complex product projects.

• Experience in mentoring product professionals or leading initiatives through indirect teams.

• Project management, Lean, or related process-improvement certifications are preferred.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Dedicated home workspace arrangement.

• Remote work with occasional travel to Humana offices for training or meetings.