Director, Medicare Product

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Director of Medicare Product Performance is a key leader responsible for driving the financial, operational, and competitive success of Medica's Medicare portfolio - spanning Medicare Advantage (MA), Medicare Supplement and Medicare Cost Plans. This role prioritizes and executes performance improvement initiatives across the segment's critical business levers - membership growth and retention, operating margin, and operational excellence - while ensuring compliance with CMS requirements and sustained competitive differentiation.

This role accelerates Medicare segment performance by connecting strategy to execution and aligning the matrix around the KPIs that matter. Through rigorous governance, decisive problem-solving, and clear executive communication, the Director ensures Medica's Medicare products are financially sound, operationally reliable, compliant, and market-competitive - delivering superior value to members, providers, and the enterprise.

• Defines and monitors Key Performance Indicators (KPIs) aligned to Medicare bid targets and segment goals; establishes transparent reporting to communicate goals and execution across the organization.
• Partners with cross-functional teams (network, pharmacy, clinical programs, Stars, risk adjustment, finance, actuarial, operations) to optimize drivers of competitiveness and address outliers.
• Identifies performance gaps and leads cross-functional remediation plans, ensuring timely execution and measurable improvement.
• Manages program deliverables and holds matrixed partners accountable for on‑time, high‑quality completion of priority initiatives.
• Regularly monitors performance of core KPIs to ensure products are performing as expected:
  • Financial & Revenue:
    Premium and risk‑adjusted revenue, margin, MLR.
  • Medical & Pharmacy Cost:
    Trend drivers, utilization, site‑of‑care optimization, formulary effectiveness, specialty pharmacy.
  • Quality & Risk Programs:
    Medicare Stars domains, HEDIS/CAHPS, risk adjustment (RAF accuracy), coding completeness.
  • Membership & Market Performance:
    Enrollment growth, retention/churn, attribution accuracy, product competitiveness.
  • Operations & Member
    
    Experience:
    • Claims:
      Auto‑adjudication rate, financial accuracy, timeliness, inventory/aging, appeal/grievance outcomes.
    • Call Center:
      First Contact Resolution (FCR), service level, NPS/CSAT, CTM case rate and resolution.
    • Provider Operations:
      Credentialing throughput, directory accuracy, dispute resolution timeliness.
    • Compliance:
      Audit readiness, regulatory turnaround times, CAP completion, issue prevention.
  • Sales & Marketing:
    Distribution performance, AEP/OEP conversion, lead quality, marketing effectiveness, broker engagement.
  • Value‑Based Care: VBC attribution, contract performance, incentive alignment, care management impact.

• Chairs the Medicare Product Performance Governance Committee, setting priorities, cadence, agendas, and driving execution of initiatives that materially influence segment performance.
• Aligns cross‑functional partners - network, clinical, pharmacy, finance, actuarial, operations, and compliance - around Medicare priorities.
• Partners with the VP/GM, Medicare to develop and execute segment strategy, portfolio optimization, and multi‑year roadmaps.
• Partners closely with business connectivity and data colleagues.

• Delivers executive‑ready insights on threats, opportunities, and infrastructure needs;…