Director, Operations Performance Office

Blue Cross of Idaho•Meridian, ID

1d•$134,960 - $202,440•Onsite

About The Position

The Director, Operations Performance Office is responsible for enterprise operational performance management across Claims, Customer Service, Membership, Payment Integrity, and related operational functions. This role leads performance governance, business analytics, quality assurance, operational compliance monitoring, continuous improvement, vendor performance, and operational analytics. The Director translates strategic objectives into measurable outcomes through KPI management, reporting, operational controls, and data-driven decision making while advancing automation and AI-enabled capabilities to improve operational effectiveness, quality, and member experience.

Requirements

Minimum of 10 years’ experience in operational analytics and reporting with at least 5 years in managing teams.
Minimum of 5 years’ experience in health plan or managed care operations, including Claims, Customer Service, Membership, Payment Integrity, or related functions.
Demonstrated success leading enterprise KPI programs, operational governance, and continuous improvement initiatives.
Experience managing vendor performance and outsourcing relationships.
Demonstrated ability and skills in Operational Performance Management, Data Analytics and Reporting, Quality Assurance, Root Cause Analysis, Operational Compliance, Vendor Governance, Lean Six Sigma, Performance Dashboard Development, KPI Framework Design, and Communication.
Experience with Artificial Intelligence (AI) and Generative AI applications
Experience with Business Intelligence and reporting platforms (Power BI, Tableau, etc.)
Ability to translate data and provide predictive analytics to improve operational excellence.
Bachelor’s degree in Business, Healthcare Administration, Analytics, or a related field, or equivalent experience (Two years of relevant work experience is equivalent to one year of college.).

Nice To Haves

Master's degree
Experience with CMS, Medicare Advantage Star Ratings, NCQA, state regulatory requirements, and healthcare operational compliance programs
Lean Six Sigma certification (Green Belt or Black Belt), PMP, or CPHQ

Responsibilities

Lead enterprise operational performance management through KPIs, SLAs, scorecards, and governance frameworks.
Facilitate operational and executive performance reviews, ensuring accountability for results and remediation plans.
Drive alignment between operational performance objectives, strategic priorities, regulatory requirements, and customer outcomes.
Monitor operational trends, risks, and performance commitments across Operations.
Support Star Ratings, HEDIS, CAHPS, and member experience performance monitoring in partnership with Quality and Stars program leadership, including performance commitments embedded in vendor agreements.
Lead operational reporting, dashboards, analytics, and business insights to support executive decision-making.
Ensure data integrity, consistency, and governance across performance metrics.
Develop predictive analytics, forecasting models, and operational intelligence capabilities to identify trends, risks, and improvement opportunities.
Drive adoption of AI, automation, and advanced analytics to improve reporting, quality monitoring, and operational decision support.
Oversee proactive and reactive quality assurance programs across operational functions.
Establish controls and monitoring practices to ensure compliance with regulatory, contractual, and organizational requirements.
Partner with Audit, Compliance, and operational leaders to address findings and implement sustainable corrective actions.
Ensure operational readiness for audits, reviews, and regulatory reporting requirements.
Lead process excellence initiatives focused on improving quality, productivity, efficiency, cost, and customer experience.
Apply Lean, Six Sigma, automation, and process redesign methodologies to achieve measurable business outcomes.
Establish vendor performance standards and monitor service delivery against contractual commitments and operational expectations.
Identify opportunities to leverage automation and emerging technologies to improve operational effectiveness.
Build and lead a high-performing team of analytics, quality, reporting, and performance professionals.
Foster a culture of accountability, innovation, continuous improvement, and data-driven decision making.
Develop organizational capabilities in performance management, analytics, automation, and operational excellence.