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.
Skills Required
- Minimum 10 years' experience in operational analytics and reporting with at least 5 years managing teams.
- Minimum 5 years' experience in health plan or managed care operations (Claims, Customer Service, Membership, Payment Integrity, or related).
- Demonstrated success leading enterprise KPI programs, operational governance, and continuous improvement initiatives.
- Experience managing vendor performance and outsourcing relationships.
- Operational Performance Management, Data Analytics and Reporting, Quality Assurance, Root Cause Analysis, Operational Compliance, and Vendor Governance.
- Experience applying Lean, Six Sigma methodologies and process redesign for measurable outcomes.
- Experience with Artificial Intelligence and Generative AI applications.
- Experience with Business Intelligence and reporting platforms (Power BI, Tableau, etc.).
- Ability to translate data into predictive analytics and operational insights.
- Bachelor's degree in Business, Healthcare Administration, Analytics, or related field, or equivalent experience.
- 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.
Blue Cross of Idaho Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Blue Cross of Idaho and has not been reviewed or approved by Blue Cross of Idaho.
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Healthcare Strength — Feedback suggests medical, dental, vision and mental‑health coverage are a standout, with affordable PPO/HSA options often cited. Role postings and third‑party summaries describe comprehensive plan choices that employees value.
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Retirement Support — Feedback suggests a 401(k) with a company match is a core element, with mentions of an additional non‑contributory employer contribution. This indicates meaningful long‑term savings support as part of total rewards.
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Leave & Time Off Breadth — Role postings specify paid time off, paid holidays, a community service day and a self‑care day. Paid family leave, adoption assistance and an EAP further extend time‑off and wellbeing supports.
Blue Cross of Idaho Insights
What We Do
Since 1945, we’ve taken our role as an Idaho-based health insurance company to heart. While the health insurance marketplace has experienced lots of change in recent years, we haven’t. As a not-for-profit, we’re mission-driven to help connect Idahoans to quality healthcare that is affordable and build strong networks and services with our customers in mind. With an annual economic impact of $456 million (in 2016), we lead the state and industry in addressing the cost of healthcare and creating transformative customer experiences with information, tools and services. Ultimately, we aim to create a brighter future for all of us. All we need are customer-centric leaders like you.
