Job Description Summary:
The Director, Operations Excellence & Performance sits within BCBSA's Health Plan Operations function and is responsible for four interconnected areas of accountability: Divisional Planning & Coordination, Performance Management, Continuous Improvement, and Duals and Marketplace Performance. The role reports directly to the Senior Vice President, Health Plan Operations.
As the divisional planning and coordination lead, this role serves as the operational backbone of Health Plan Operations — owning portfolio reporting, budget coordination, AI initiative tracking, and continuous improvement project oversight across the division. As the performance management lead, this role ensures all segments operate within a consistent, accountable, and audit-ready performance framework. As the enterprise CI leader, this role owns the design and execution of BCBSA's continuous improvement discipline across all Health Plan Operations programs. As BCBSA's primary subject matter expert on Duals and Individual Market, this role leads strategy development and provides consultative advisory support to BCBSA leadership and Blue Plans across the System.
This role partners across BCBSA functions — Finance, Enterprise Technology, Data and Analytics, Legal, Compliance, Regulatory Affairs and FEP Operations — as well as with Blue Plan CFOs, CMS, OPM, state Medicaid agencies, and third-party vendors to coordinate divisional deliverables, validate performance results, sustain improvement gains, and maintain regulatory compliance across a complex, multi-segment portfolio.
Responsibilities include but are not limited to
Continuous Improvement
- Own the design and execution of BCBSA's Health Plan Operations continuous improvement discipline — establishing the CI strategy, methodology standards, and operating model across all programs: Government Markets, Inter-Plan Programs (BlueCard, BlueSquared, BlueExchange, ITS), FEP Medicare Advantage EGWP, Duals, and Market Performance.
- Partner with segment leaders to identify process inefficiencies, pain points, and high-value improvement opportunities across the division.
- Lead and facilitate Lean/Six Sigma project teams, kaizen events, and DMAIC cycles across all segments from scoping through sustained implementation.
- Establish value-stream mapping for core operational workflows for all Health Plan Operations processes.
- Build and lead a team of CI professionals; develop and administer the Health Plan Operations CI training curriculum, including Lean Six Sigma green belt and yellow belt programs; cultivate CI champions across all segments to embed improvement capability at the front-line level.
- Partner with Finance to validate CI savings estimates and ensure accurate attribution of CI-driven productivity gains across the division.
Performance Management
- Own enterprise performance reporting across all Health Plan Operations segments — Inter-Plan Programs, FEP Medicare Advantage, Government Markets, Duals, Individual Market, and Market Performance — ensuring the SVP and BCBSA leadership have accurate, timely, and decision-ready operational intelligence.
- Design and maintain segment-specific scorecards and executive dashboards that integrate operational health, financial performance, regulatory compliance posture, and member experience outcomes across all programs in a single, coherent view.
- Establish performance reporting cadences — weekly operational, monthly executive, and quarterly planning — with standardized metrics definitions and templates that enable meaningful cross-segment comparison and trend analysis.
- Partner with Finance, FEP Medicare Advantage, and Plan counterparts to reconcile performance data against program financial results and CMS/OPM encounter data submissions; translate performance reporting into executive narratives for the FEP Board of Managers, BCBSA Board committees, and CFO-level planning forums.
- Establish accountability structures, operating rhythms, decision rights, and escalation protocols across all Health Plan Operations segments; lead recurring planning forums including segment performance reviews and cross-segment risk reviews.
- Develop and maintain the Health Plan Operations policy and SOP library, ensuring all segments operate within consistent, documented, and audit-ready standards; partner with Legal and Compliance to ensure standards reflect current regulatory obligations.
- Serve as the primary owner of Health Plan Operations' audit readiness posture — coordinating evidence collection, corrective action tracking, and response documentation for CMS, OIG, and BCBSA internal audits across all segments.
Duals & Marketplace Performance
- Lead Individual Market strategy and SME support for the Blue System, encompassing ACA Marketplace (on- and off-exchange), Special Enrollment Period (SEP) processing, premium tax credit reconciliation, risk adjustment, and QHP certification obligations; serve as BCBSA's consultative resource to Plans on Individual Market product, operations, and regulatory compliance.
- Monitor Individual Market regulatory developments and synthesize competitive and regulatory intelligence into strategic briefings for the SVP, BCBSA leadership, and Plan executives.
- Partner with BCBSA Government Markets, Policy, and Legal teams to represent Blue System interests in CMS, CMS-CMMI, and state-level Individual Market policy discussions; support comment letter development and stakeholder engagement on relevant regulatory proposals.
- Develop and disseminate System-wide Individual Market best practices, playbooks, and operational frameworks that Plans can adapt to their market context; facilitate peer learning and cross-Plan knowledge sharing on strategy and execution.
Divisional Planning & Coordination
- Serve as the planning and coordination hub for Health Plan Operations — owning the division's portfolio of strategic and operational deliverables and ensuring the SVP has a real-time, integrated view of divisional priorities, progress, and risks.
- Own and manage Health Plan Operations portfolio reporting — consolidating project status, milestones, risks, and outcomes across all segments and initiatives into a single, executive-ready view for the SVP and BCBSA leadership.
- Lead annual and multi-year budget planning and coordination for Health Plan Operations, partnering with segment leaders and Finance to develop, track, and report on divisional budgets; monitor actuals against plan and surface variances with recommended actions.
- Track, coordinate, and report on AI initiatives across the Health Plan Operations division — maintaining a consolidated inventory of AI projects, implementation status, vendor relationships, and outcomes; ensure AI investments are aligned to divisional priorities and that progress is visible to the SVP and executive stakeholders.
- Own the Health Plan Operations CI project portfolio — tracking active continuous improvement initiatives across all segments, ensuring project owners are accountable to milestones, and reporting aggregate CI progress and financial impact to the SVP on a regular cadence.
- Coordinate divisional deliverables across segments, ensuring alignment on timelines, dependencies, and resource commitments; proactively identify and resolve coordination gaps before they become execution risks.
- Develop and maintain the Health Plan Operations operating calendar — governance forums, reporting cycles, planning milestones, regulatory deadlines, and board deliverables — ensuring the division operates on a disciplined, forward-looking cadence.
- Prepare and coordinate executive briefings, board materials, and divisional communications on behalf of the SVP, ensuring consistent quality, accuracy, and narrative alignment across all Health Plan Operations outputs.
The posting range for this position is:
154,300.00 - 223,750.00
Required Education, Certifications and Experience
Education
- Required BS in Business Administration, Healthcare Administration, Industrial Engineering, Operations Management; or equivalent experience
- Preferred MS MBA, MHA or equivalent strongly preferred
Experience
- Required 10+ Years progressive experience in operations, process improvement, or operational performance management.
Knowledge Skills and Abilities
- Demonstrated experience in a health plan, managed care organization, or health insurance operations environment; direct experience across multiple lines of business — Medicare, Medicaid, Duals, Individual Market, or inter-plan programs — strongly preferred; subject matter expertise in Medicare-Medicaid dual-eligible programs and policy is a significant differentiator.
- Proven track record leading large-scale, cross-functional improvement initiatives with measurable financial and operational outcomes across a complex, multi-segment portfolio.
- Experience leading divisional planning, portfolio coordination, and budget management functions in a matrixed organization; track record of building performance reporting structures and executive accountability mechanisms across a complex portfolio.
- Experience partnering with finance functions to validate savings estimates and productivity claims; familiarity with actuarial or program economics contexts is an asset.
- Strong command of DMAIC, value stream mapping, PDCA, kaizen, and root-cause analysis methodologies.
- Familiarity with CMS, CMS-CMMI, and state Medicaid agency regulatory requirements across Medicare, Duals, and Individual Market lines of business; HEDIS/Stars quality measurement; and NCQA/URAC accreditation standards.
- Proficiency with operational analytics, dashboard development, performance reporting, and KPI design; experience with tools such as Tableau, Power BI, or equivalent; familiarity with portfolio management and project tracking platforms (e.g., Smartsheet, Azure DevOps, or equivalent).
- Demonstrated ability to track, coordinate, and report on AI and technology initiatives across a large division; working knowledge of AI use cases in health plan operations is a differentiator.
- Familiarity with BlueCard, Inter-Plan settlement, or FEP program operations is a significant differentiator.
- Demonstrated ability to influence and drive accountability across organizational boundaries without direct line authority across a large, matrixed portfolio.
- Executive presence and communication skills; comfortable presenting to boards, C-suite, Blue Plan CFOs, CMS, and OPM audiences.
- Strong planning and change management capability — track record of building enterprise operating rhythms, coordinating complex divisional portfolios, and driving sustained adoption of new standards across a matrixed organization.
- Analytical rigor paired with strategic judgment; able to translate complex, multi-segment data into decision-relevant executive insight.
- Commitment to building team capability and a durable culture of continuous improvement across a diverse, multi-segment operational scope.
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The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
