Lead Insurance Product Manager - Part D/PDP

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Humana is seeking a Medicare Part D expert to join the team as a Lead Insurance Product Manager who is ready to shape PDP strategy, guide complex decisions and turn regulatory requirements into executable products. As Lead Insurance Product Manager for PDP Strategy & Execution, you’ll serve as the product lead for Humana’s standalone Prescription Drug Plan portfolio. You’ll connect Medicare Part D strategy to accurate, compliant and timely execution across the full product lifecycle, from early market and regulatory assessment through bid development, filing, implementation and annual readiness.

You’ll bring together Product, Pharmacy, Actuarial, Finance, Regulatory Compliance, Legal, Operations, Marketing, Sales, Digital, member communications and program delivery partners to make complex decisions, resolve competing priorities and translate approved strategy into a clear execution path. You’ll assess member, regulatory, financial and operational tradeoffs and provide recommendations that help leaders make informed decisions.

This role is designed for an advanced individual contributor who operates with significant independence, leads through expertise and influence, and raises the standard for PDP product management. You’ll guide other associates and work groups, establish methods and priorities for complex initiatives, strengthen governance and reusable tools, and build shared capability so critical knowledge and accountability extend beyond one subject matter expert.

Key Role Functions

Shape PDP Portfolio Strategy and Direction

• Lead year-round PDP product strategy and execution, translating enterprise priorities, customer needs, market dynamics, regulatory requirements and financial considerations into actionable portfolio recommendations
• Integrate competitive, financial, regulatory, operational and member insights to evaluate product opportunities, risks and tradeoffs
• Analyze competitor participation, premiums, deductibles, cost sharing, formulary positioning and emerging market trends to identify implications for Humana’s PDP portfolio
• Develop recommendations for new or enhanced benefits, product features and market approaches, including the business rationale, member impact, operational dependencies, risks and implementation path
• Look beyond the immediate bid cycle to anticipate future portfolio needs, policy changes and market shifts and position partners for effective execution
• Represent PDP Product Management in strategy and leadership forums, communicating the recommendation, supporting insights, tradeoffs and decisions needed

Lead PDP Bid, Benchmark and Filing Execution

• Lead product strategy and readiness across the annual PDP bid cycle, including benefit design coordination, bid submission readiness, PBP Section Rx and HPMS activities, validation resolution and alignment across key functions
• Coordinate benchmark, de minimis, rebate reallocation, desk review and related PDP activities, ensuring impacts, options, decisions and accountable owners are clear
• Lead review and resolution of filing questions, validation findings, audit exhibits and other CMS submission issues, escalating material product risks at the appropriate time
• Establish working plans, governance, decision points and controls that support accurate, timely and compliant submissions
• Maintain clear records of assumptions, decisions, dependencies, risks, status and ownership throughout the bid cycle
• Provide final product-level review and sign-off for designated PDP submissions and deliverables consistent with established governance

Translate Regulatory Change and Lead Feasibility

• Interpret CMS guidance and Medicare Part D policy changes and translate them into clear product implications, requirements, decisions and downstream impacts
• Lead feasibility assessments across product, regulatory, actuarial, financial, pharmacy, operational, technology and member-experience considerations
• Separate immediate compliance needs from longer-term product opportunities and recommend a practical path forward when guidance or operating conditions are ambiguous
• Lead Product participation in new Part D opportunities, including CMMI demonstrations and emerging pharmacy programs, from concept evaluation through implementation
• Identify gaps in products, processes, controls or decision rights; use root-cause analysis to recommend sustainable solutions rather than one-time fixes

Drive Readiness, Implementation and Member Experience

• Lead annual PDP readiness from bid approval through AEP and January 1 implementation, coordinating milestones, dependencies, issue resolution and leadership-level status reporting
• Partner with Marketing, Sales, Digital, member-material and operational teams to ensure benefit messaging and product information are accurate, consistent and easy to understand
• Provide PDP subject matter expertise for product data, member materials, digital tools, training, operational processes and downstream readiness
• Partner with functional owners to confirm implemented benefits and member-facing information align with approved product decisions and CMS filings
• Assess readiness and product risk using clear evidence, surface issues early and drive accountable owners toward resolution

Lead SPAP Strategy and Execution

• Lead PDP Product support for State Pharmaceutical Assistance Program requests for information, evaluations, contracting support and implementations
• Coordinate product requirements and decisions with state program contacts and internal Legal, Compliance, Pharmacy, Operations, Finance, member communications and implementation partners
• Assess potential impacts to premiums, LIS coordination, member cost sharing, communications, systems and operational processes
• Create clarity around scope, decision rights, dependencies and escalation paths and communicate material risks or unresolved decisions to leadership

Strengthen Governance, Quality and Product Capability

• Establish and maintain standards, controls and reusable tools that strengthen quality, consistency and accountability across PDP strategy, filings and readiness
• Use data, lessons learned and root-cause analysis to improve processes and reduce recurring defects, rework and unnecessary manual activity
• Serve as the business subject matter expert for automation and product-data initiatives, translating Part D rules and user needs into practical business requirements and controls
• Provide functional leadership, coaching and subject matter guidance to Product Managers and cross-functional partners without relying on formal authority
• Lead associates and work groups in determining methods, analytical approaches, priorities and timelines for complex assignments
• Build cross-training, documentation and backup coverage so critical knowledge is shared and the organization can operate with greater resilience

Influence Decisions and Lead Through Complexity

• Facilitate decisions when member, regulatory, financial, operational and market considerations require tradeoffs
• Exercise independent judgment on complex issues, distinguish material product risk from routine execution matters and escalate appropriately
• Bring structure to ambiguous work by defining the problem, aligning stakeholders on the outcome and establishing a clear path to resolution
• Communicate concise, evidence-based recommendations for working teams, senior leaders and executive audiences
• Build trusted partnerships that allow issues to surface early and support timely, transparent decisions and collective accountability

Key Partnerships & Reporting Relationship

You’ll report to the Director, Insurance Product Management and serve as the primary CPES lead for PDP product strategy and execution. You’ll work closely with leaders and subject matter experts across Pharmacy, Part D Strategy, Actuarial, Finance, Regulatory Compliance, Legal, Operations, Marketing, Sales, Digital, Process Improvement & Program Delivery, member communications and other Product Management teams. This is an advanced individual-contributor role and does not require formal people-management authority.

Use your skills to make an impact

Required Qualifications

• 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

• Demonstrated ability to interpret CMS regulatory, contractual or operational guidance and translate it into product requirements, decisions and execution plans

• Demonstrated experience leading complex cross-functional projects, processes or work groups with minimal instruction

• Proven 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

Preferred Qualifications

• 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

Additional Information

What Success Looks Like

• Lead through expertise. Operate as an advanced Medicare Part D subject matter expert who independently determines methods, priorities and approaches for complex work

• Create clarity from complexity. Translate ambiguous regulatory, financial and operational issues into clear recommendations, decisions, ownership and next steps

• Think portfolio-first. Connect individual benefit and filing decisions to broader member value, market position, financial performance, compliance and enterprise priorities

• Deliver with discipline. Enable accurate, timely and compliant bids, filings and readiness outcomes with risks surfaced early and decisions documented clearly

• Influence across boundaries. Create alignment among leaders and functions with different priorities without relying on formal authority

• Raise the standard. Build governance, controls, tools and repeatable practices that leave PDP Product Management stronger after each cycle

• Build shared capability. Coach others, share knowledge and create durable backup coverage rather than concentrating expertise with one person

• Focus on outcomes. Use data, sound judgment and functional expertise to move work from activity to measurable product, member and business outcomes

• Anticipate what is next. Maintain a forward-looking view of regulatory, portfolio and operating needs while remaining accountable for near-term execution

How You’ll Lead

How you achieve results matters as much as what you deliver. You’ll bring the Humana Values and the Humana Way to life through customer-focused decisions, clarity, bold and responsible action, forward-looking planning and shared accountability.

• Live by the Golden Rule by listening first, seeking to understand the member and partner experience, and remaining open to perspectives that challenge initial assumptions

• Keep it simple by turning complex Part D requirements into clear insights, practical decisions and technology-enabled ways of working

• Play to win by focusing on outcomes, taking calculated risks, making timely decisions and learning quickly when conditions change

• Keep your eyes on the horizon by anticipating regulatory and market shifts, establishing the endpoint and dynamically adjusting the roadmap

• Play as one team by sharing expertise and capacity, strengthening cross-functional collaboration and holding partners collectively accountable for the outcome

Role Expectations

• Operate with significant independence within established enterprise, segment and functional strategies, policies and governance

• Serve as a P4 Lead-level individual contributor: an advanced subject matter expert who establishes priorities and timelines, leads complex projects and processes, and provides direction to work groups

• Exercise independent judgment on complex and diverse issues and develop creative, practical solutions using deep experience and knowledge of best practices

• Influence functional strategy and results through recommendations, decision leadership, process improvement and cross-functional execution

• Balance strategic thinking with hands-on ownership of critical PDP decisions and deliverables

• Lead multiple high-priority workstreams, reprioritize quickly and remain effective during compressed CMS and bid-cycle timelines

• Create sustainable improvements rather than relying on individual heroics or repeated escalation

• The work follows the annual Medicare Part D and CMS regulatory cycle. Certain periods require additional flexibility, including extended hours and occasional weekend work, to meet critical regulatory and business deadlines

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$115,200 - $158,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 11-11-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Originally posted on Himalayas