Freelance Remote Risk Adjustment Coder Jobs in Pennsylvania

Job Summary

Reporting to the President of Exchange Markets, the Corporate Director of Strategy & Product Development - Exchange is responsible for the end-to-end strategy, design, development, and lifecycle management of ACA-compliant products offered on and off the Health Insurance Marketplace. This role serves as a leader and subject matter expert on ACA regulations, market dynamics, and consumer needs, translating complex regulatory requirements into competitive, compliant, and consumer-centric products.
The director partners cross-functionally with Actuarial, Compliance, Legal, Network, Marketing, Sales, and IS to deliver products that meet regulatory requirements, achieve financial targets, and improve member experience in a rapidly evolving regulatory and competitive landscape.
In addition to product development responsibilities, the role plays a critical part in shaping the overall strategic direction of the Exchange segment. The director partners with the President of Exchange Markets to develop and execute segment-level business strategies, including market positioning, growth initiatives, competitive differentiation, and long-term portfolio planning. The director serves as a key advisor in translating strategy into actionable roadmaps, ensuring that product innovation and segment priorities are tightly integrated to drive sustainable growth, profitability, and market relevance.

Work Arrangement: Fully Remote; must be able to accommodate Eastern Time Zone hours.

Essential Functions:

• Define and execute the product strategy and multi-year roadmap for ACA Marketplace plans, aligned with corporate growth, margin, and membership growth.
• Lead product portfolio decisions, including plan design, metal tier strategy, benefit richness, pricing positioning, and growth/contraction considerations.
• Monitor and respond to market trends, competitor offerings, broker feedback, regulatory changes, and consumer behavior to ensure products remain competitive and compliant.
• Oversee the development of ACA-compliant plan designs, including EHBs, cost-sharing structures, CSR variants, and network configurations. Partner with Marketing, Sales and Brokers to ensure clear plan positioning, benefit communication, and Marketplace display accuracy.
• Track post-launch performance, including risk mix, retention, and member experience, to lead ongoing product optimization efforts
• Lead, mentor, and develop a team of product managers and foster a culture of accountability, collaboration, and continuous improvement
  

Education

• Bachelor's Degree required
• Master's Degree preferred

Experience:

• 10 plus years of progress experience with health insurance, managed care ACA/Exchange products
• Deep knowledge of ACA regulations, CMS guidance, metal tier requirements, AV modeling concepts, and Marketplace operations
• Proven experience leading cross-functional teams and influencing senior stakeholders without direct authority.
• Strong analytical skills with the ability to interpret actuarial, financial, and market data to inform product decisions
• Experience with CMS QHP submissions, SERFF filings, and regulatory review cycleExperience working for a health plan, carrier operating in multiple states
• Familiarity with risk adjustment strategy and its impact on product design
• Experience launching products in both Federally Facilitated and State-Based Marketplaces (helpful but not required)
  

Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more. For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities.

A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.