VP, Benefit Plan Design & Strategy

VP of Benefit Plan Design & Strategy

Harbor Health

POSITION OVERVIEW

Harbor Health is looking for a VP of Benefit Plan Design & Strategy to lead the design of our health plan portfolio, both large group and ACA Individual/Family Marketplace products. This is a senior product leadership role reporting to our Chief Product Officer, and it sits right at the center of how Harbor Health turns our payvider model into plans members actually want to buy. You’ll own plan design end to end: benefit structure, metal tier and actuarial value strategy, filing and compliance, and the creative thinking that makes our plans stand out in a crowded market. This is a builder’s seat at a company still writing its own rulebook, so it takes real depth and real range.

POSITION DUTIES & RESPONSIBILITIES

• Lead the design and continuous evolution of Harbor Health’s large group and ACA Individual/Family Marketplace plan portfolios, using data-driven modeling and rapid prototyping to take new benefit structures from concept through go-to-market

• Partner closely with actuarial, network, and compliance teams, building and validating pricing, cost-share, and utilization models so that designs are accurate, competitive, and compliant with CMS and state DOI requirements

• Own the ACA metal tier and actuarial value strategy, using AV calculator analysis and scenario modeling to test non-traditional cost-sharing structures that stay within essential health benefit requirements while differentiating Harbor Health in the Marketplace

• Drive the annual plan filing strategy, partnering with legal, compliance, and finance, and streamlining filing workflows through automation and templated, reusable data structures to meet state and federal deadlines

• Challenge conventional plan design norms with creative, member-centered thinking, leveraging claims and member data, emerging technologies, and novel benefit mechanisms to differentiate Harbor Health’s plans beyond price

• Build and present data-backed plan strategy and portfolio recommendations to executive leadership, translating complex technical analyses into clear business cases

• Monitor competitor plan filings, market trends, and regulatory changes, applying analytical tools to benchmark the market and anticipate where design opportunities are emerging

• Mentor and develop team members as the plan design function grows, building technical capability and an experimentation mindset across the team

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

Required

• 10+ years of experience in health plan product or plan design, with direct, hands-on experience designing large group commercial plans

• Deep understanding of actuarial value calculations, metal tier structuring, essential health benefits, and CMS/state DOI filing requirements

• Experience at a payer, payvider, or health plan, with a track record of plans that succeeded in the market, not just on paper

• Strong cross-functional partnership skills. You’ll work daily with actuarial, network, compliance, clinical, and finance leaders

• A genuinely creative approach to plan design. This role needs someone who can look at a benefit structure and find an angle nobody else has tried

• Bachelor’s degree required; an advanced degree in health administration, actuarial science, or a related field is a plus

Preferred

• Direct, hands-on experience designing and filing ACA Individual/Family Marketplace plans (preferred, not required)

WHAT WE OFFER

• Opportunity to shape how Harbor Health designs and brings health plans to market, both large group and ACA Individual/Family, from the ground up

• Collaborative and dynamic work environment

• An organization made of people who are passionate about changing the healthcare landscape

• Competitive salary and benefits package

• Professional development and growth opportunities

• A transparent and unique culture

COMPANY OVERVIEW

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

EQUAL EMPLOYMENT OPPORTUNITY

Harbor Health is an Equal Opportunity Employer. We celebrate diversity and are committed to building an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.