Medicare Service Operations Director

Blue Cross Blue Shield of Michigan•Detroit, MI

About The Position

Responsible for planning, organizing and leading multiple business units. Develop the vision and strategic direction for the business units. Identify corresponding plans and priorities to achieve business unit and organizational goals. Evaluate resource availability and business unit objectives to make decisions. Direct the activities of assigned business units including strategic planning, problem-solving, staff development and communication. Develop goals and objectives for assigned business units that supports the organizations strategy, products and services. Collaborate across business units with key stakeholders to align business objectives. Oversee the development and implementation of business unit policies, systems and processes. Lead, direct, evaluate and develop business unit leadership and team members. Provide effective and efficient solutions to complex business problems. Prepare and present formal presentations, documents, updates, etc. to executive leadership. Key Responsibilities Lead and develop large, complex contact center operations supporting both members and providers across internal teams and external vendor partners. Build, coach, and sustain a strong leadership team and culture that prioritizes accountability, engagement, collaboration, and continuous improvement. Navigate and balance competing service priorities by influencing stakeholders and anticipating member and provider impact across policy, process, and operational decisions. Serve as the operational owner for service performance outcomes, including customer experience metrics, employee engagement, and operational effectiveness. Partners across the organization to proactively identify service risks, raise issues upstream, and drive solutions that reduce avoidable customer abrasion. Serve as a key business leader for large scale initiatives impacting Medicare Servicing, including technology, process, and service model changes. Maintain strong working knowledge of Medicare Advantage requirements, CMS regulations, HIPAA, security standards, and MA servicing workflows to ensure compliant and effective service delivery. All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Requirements

Bachelor's Degree in a related field is required. Master's Degree in a related field is preferred.
Five (5) years of experience in a related field is required.
Previous experience leading a team is required.
Ability to effectively lead, coach and develop team members.
Ability to foster teamwork and work effectively in a cross-functional team environment.
Advanced organizational, planning, analytical and problem-solving skills.
Ability to solve practical problems and deal with moving variables in situations with limited standardization and alignment.
Advanced knowledge of corporate organizational structures, including functional responsibilities.
Advanced verbal, written communication and interpersonal skills.
Ability to influence others to achieve business unit objectives.

Nice To Haves

Experience leading high volume contact center operations in a complex customer service environment.
Demonstrated ability to lead through change, influence without authority, and operate effectively in a matrixed organization.
Knowledge and experience with Medicare Advantage, CMS requirements, Star Ratings, and CAHPS, including how servicing operations directly impact member perception and quality outcomes.
Experience managing both bargaining unit and non bargaining unit employees.
Strong relationship building skills with internal leaders, external partners, and vendor organizations.

Responsibilities

Planning, organizing and leading multiple business units.
Develop the vision and strategic direction for the business units.
Identify corresponding plans and priorities to achieve business unit and organizational goals.
Evaluate resource availability and business unit objectives to make decisions.
Direct the activities of assigned business units including strategic planning, problem-solving, staff development and communication.
Develop goals and objectives for assigned business units that supports the organizations strategy, products and services.
Collaborate across business units with key stakeholders to align business objectives.
Oversee the development and implementation of business unit policies, systems and processes.
Lead, direct, evaluate and develop business unit leadership and team members.
Provide effective and efficient solutions to complex business problems.
Prepare and present formal presentations, documents, updates, etc. to executive leadership.
Lead and develop large, complex contact center operations supporting both members and providers across internal teams and external vendor partners.
Build, coach, and sustain a strong leadership team and culture that prioritizes accountability, engagement, collaboration, and continuous improvement.
Navigate and balance competing service priorities by influencing stakeholders and anticipating member and provider impact across policy, process, and operational decisions.
Serve as the operational owner for service performance outcomes, including customer experience metrics, employee engagement, and operational effectiveness.
Partners across the organization to proactively identify service risks, raise issues upstream, and drive solutions that reduce avoidable customer abrasion.
Serve as a key business leader for large scale initiatives impacting Medicare Servicing, including technology, process, and service model changes.
Maintain strong working knowledge of Medicare Advantage requirements, CMS regulations, HIPAA, security standards, and MA servicing workflows to ensure compliant and effective service delivery.