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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare Part D product strategy, including bid submissions, regulatory compliance, and cross-functional project leadership. Proficient in interpreting CMS guidance and translating it into actionable product requirements and execution plans.
Highest-signal resume keywords
Medicare Part D Product StrategyPDP Bid SubmissionCMS Regulatory InterpretationCross-Functional Project LeadershipProcess Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medicare Part D ExperiencePDP Product Lifecycle ManagementBenefit ImplementationData AnalysisGovernance and Quality ControlsBenefit Design CoordinationCompetitive IntelligenceBusiness Requirements DevelopmentAudit Exhibit ManagementFormulary Coordination
Soft Skills
Excellent Written CommunicationVerbal CommunicationFacilitation SkillsPresentation SkillsIndependent Judgment
Tools & Technologies
HPMSPBP Section RxAutomation ToolsDigital ToolsMember-Facing Benefit Messaging
Certifications & Qualifications
Project Management CertificationLean Certification
Industry Keywords
HealthcareHealth PlanPrescription Drug PlansCMMI DemonstrationsState Pharmaceutical Assistance Program
About the role
Key responsibilities & impact- Lead year-round Medicare Part D/PDP product strategy and execution
- Evaluate competitive, financial, regulatory, operational and member insights to recommend portfolio actions
- Develop recommendations for new or enhanced benefits, product features and market approaches
- Lead annual PDP bid-cycle activities, including benefit design coordination, bid submission readiness, PBP Section Rx, HPMS, validation resolution and cross-functional alignment
- Coordinate benchmark, de minimis, rebate reallocation, desk review and related PDP activities
- Lead resolution of filing questions, validation findings, audit exhibits and CMS submission issues
- Establish governance, decision points and controls for accurate, timely and compliant submissions
- Interpret CMS guidance and Medicare Part D policy changes into product requirements and execution plans
- Lead feasibility assessments across product, regulatory, actuarial, financial, pharmacy, operations, technology and member-experience functions
- Lead new Part D opportunities, including CMMI demonstrations and emerging pharmacy programs, from concept through implementation
- Lead annual PDP readiness through AEP and January 1 implementation
- Coordinate member-facing benefit messaging, product information, digital tools, training and operational readiness
- Lead PDP support for State Pharmaceutical Assistance Program requests, evaluations, contracting support and implementations
- Establish standards, controls and reusable tools for PDP strategy, filings and readiness
- Improve processes using data, lessons learned and root-cause analysis
- Serve as business subject matter expert for automation and product-data initiatives
- Provide functional leadership, coaching and subject-matter guidance without formal people-management authority
- Facilitate complex decisions, communicate evidence-based recommendations and escalate material risks
- Report to the Director, Insurance Product Management and serve as primary CPES lead for PDP product strategy and execution
Requirements
What you’ll need- Bachelor’s degree
- 5+ years of relevant healthcare, health plan, Medicare, product management or related experience, including substantial Medicare Part D experience
- Direct experience with standalone Prescription Drug Plans and the Medicare Part D product lifecycle
- Experience leading Medicare Part D product strategy, bids, filings, benefit implementation or annual readiness activities
- Ability to interpret CMS regulatory, contractual or operational guidance and translate it into product requirements, decisions and execution plans
- Experience leading complex cross-functional projects, processes or work groups with minimal instruction
- Ability to exercise independent judgment, analyze complex information and present clear recommendations and tradeoffs to senior leaders
- Excellent written, verbal, facilitation and presentation skills
- Ability to work extended hours and occasional weekends during critical CMS, bid and implementation periods
- Deep hands-on experience with PDP bid submission, PBP Section Rx, HPMS, audit exhibits, benchmark, de minimis, rebate reallocation or desk review activities
- Knowledge of LIS, SPAP, formulary coordination, Part D member materials and AEP readiness
- Experience with competitive intelligence, CMMI demonstrations or implementation of new CMS pharmacy initiatives
- Experience developing business requirements for automation, process improvement, product data or benefit-authoring tools
- Experience creating governance, quality controls, metrics or reusable operating mechanisms for complex product work
- Experience coaching product professionals or leading work through indirect teams
- Project management, Lean or related process-improvement certification preferred
Benefits
Comp & perks- Bonus incentive plan based upon 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