Director, Operations Performance Office

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.

This position reports to the Chief Information & Operations Officer and is located at the corporate headquarters in Meridian, Idaho. #LI-Onsite

Key Responsibilities:

Performance Management & Governance

• 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.

Analytics, Insights, & Operational Intelligence

• 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.

Quality, Compliance & Risk Management

• 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.

Continuous Improvement & Vendor Oversight

• 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.

Leadership

• 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.

To be considered for this opportunity, you have the following:

Experience:

• 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.

Education: 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.). Master’s degree preferred.

We’d also love it if you had:

• 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

As of the date of this posting, a good faith estimate of the current pay range is: $134,960 - $202,440. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data.

At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.