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 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. 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. 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. 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. Salary 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. Benefits 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 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. Equal Opportunity 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. Equal Opportunity is the Law EEO is the Law Supplement E-Verify Pay Transparency Blue Cross of Idaho has taken our role as an Idaho-based health insurance company to heart since 1945. As a not-for-profit, we are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services. We aim to create a brighter future for all with the help of customer-centric professionals. Your Health and Wellness Matters At Blue Cross of Idaho, we care about the health and well-being of our employees. Our benefits aim to help make your life easier, healthier and more balanced. Your Career Development Matters We believe in employee growth, which is why we offer training, tools and numerous resources to assist with professional development. Your Community Matters Our employees care deeply about Idaho. We work together to positively impact communities throughout Idaho, and contribute our time through volunteering. Blue Cross of Idaho will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully use electronic and online job application systems. #J-18808-Ljbffr Blue Cross of Idaho