Director, Employer Segments (Healthcare Product ASO/FI)

Posted yesterday

emblemhealthNew York (NY)

Medical and Health Services Managers Direct Health and Medical Insurance Carriers

SENIORITY

Manager

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About the role

Summary of Position: Responsible for translating, implementing and operationalizing the product strategy across all employer-facing lines of business: Large Group Fully Insured (LG FI), Small Group Fully Insured (SG FI), ASO/Self-Insured, Level Funded in addition to joint / shared administration arrangements and Ancillary products. Support the organization's strategy to grow FI, Self-Funded and Level Funded membership, modernize its administration platform, compete for joint-administration accounts, and launch innovative large group product capabilities the market expects. Maintain and enhance the existing employer book, redesign the administration model for scalability and compliance, drive joint administration implementation with TPA and co-carrier partners, support the build and implementation of new ASO capabilities and lead the FI and ancillary product platforms. Responsible for translating the department’s Employer Segment’s business priorities into market-ready, financially sound and operationally executable product designs and for holding the team accountable for on-time delivery, regulatory readiness and product quality across the full employer book. Partner with sales leadership in client facing presentations serving as the product subject matter expert who fields questions and articulates technical and operational details in real time.

Principal Accountabilities: Drive product delivery and implementation of the employer segment strategy across LG FI, SG FI, ASO/Self-Insured, Level Funded and Ancillary products. Define the multi-year product roadmap aligned to GM’s P&L priorities, growth targets and competitive positioning. Lead ASO product management and operations with deep subject matter expertise in self-funded employee benefits. Define ASO standard vs. non-standard product guardrails and value proposition and shape the service model in partnership with the areas that own its components (admin services, reporting, stop loss, care management).Responsible for benefit design standards and regulatory filing strategy for the employer book. Set medical benefit templates, plan structures and network configurations for LG FI and SG FI. Ensure all employer products are rate-able, DFS compliant, and aligned with actuarial pricing assumptions. Lead, develop and hold accountable a team (ASO Products, FI & SG Products, Ancillary). Set clear role expectations, provide coaching and development, conduct performance reviews and build a high-performing product team capable of executing across all employer LOBs. Partner with the GM, Employer Segment and Sales leadership to translate employer market priorities into clear product direction. Support RFP responses, broker strategy and account-level product decisions. Bring product expertise into go-to-market conversations and ensure the Sales team is equipped with competitive, accurate product positioning. Collaborate on employer product growth efforts. Identify opportunities across ASO and LG expansion, SG retention, and ancillary product to deepen product penetration within the existing employer book, driving greater adoption of ancillary lines alongside the core medical plan in partnership with sales and account management. Coordinate cross-functionally across Actuary, Legal, Compliance, IT, Network, Operations, Communications and more to move products from design to launch-ready state. Serve as the primary decision-maker and escalation point for employer product issues. Represent the employer product function in executive forums, and regulatory discussions.

Qualifications:

Education, Training, Licenses, Certifications
Bachelor's degree in Business, Health Administration, Public Health, Finance or related field required.
Master's degree (MBA, MHA, MPH) strongly preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities10 – 12+ years of progressive experience in health insurance product management. (Required)5+ years’ experience at a director or senior leadership level. (Required)
Deep ASO/self-funded product expertise is required. Candidates must demonstrate hands-on experience designing and managing ASO product platforms, service models, stop-loss structures and employer-specific configurations in a regulated health plan environment. (Required)
Fully Insured product experience across Large Group and/or Small Group markets, including benefit design, ACA compliance, DFS filing requirements and community rating rules in New York. (Required)
Proven experience leading a team of product professionals. Demonstrated ability to hire, develop and hold accountable a team of Leaders or Senior Managers. (Required)
Strong cross-functional partnership skills. Track record of successful collaboration with Actuarial, Sales, Legal, Compliance, Network and Operations functions in a health plan. (Required)
Regulatory knowledge of New York market requirements (DFS, ACA, ERISA, NYS DFS rate filing processes). (Required)
Ancillary product experience (Dental, Vision, Rx). (Preferred)
Exceptional communication skills, both verbal and written. Ability to present product strategy clearly to executive leadership, Sales leadership and external stakeholders. (Required)

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