Job Description

Your Role

The ​Health Plan Operations (HPO)​ team ​provides operational support to Blue Shield of California​. The ​Director, Health Plan Operations​ Optimization leader will report to the Vice President, Health Plan Operations. In this role you will work across all the Health Plan Operations teams to drive an operating model that is efficient and provides outcomes worthy of our family and friends. You will drive the strategic direction to improve Health Plan Operations performance and stakeholder satisfaction while streamlining processes and lowering administrative costs. You will govern the HPO Business Optimization program portfolios for HPO team in Customer Experience, Claims, Healthcare Business Operations and end-to-end Backoffice operations. You will also provide hands-on dives and analysis of key performance issues to identify solutions. 

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Serve as a strategic leader in collaboration with all Health Plan Operations leaders, examining HPO processes and analytics to gain insights to drive short- and long-term planning and strategy

• Provide thought leadership to the Health Plan Operations organization and other cross-functional leaders throughout BSC and Stellarus - employing tools of analysis learned through previous experience in management consulting (or similar within a healthcare enterprise)

• Direct and guide leadership teams in designing and implementing operating plans that deliver on immediate business needs while advancing long-term strategic goals,

• Provide executive oversight and leadership to managers responsible for creating and driving implementation of operating plans, which are required to support immediate and long-term requirements and business strategies​ 

• Define and execute a strategic roadmap to modernize health plan operations, delivering measurable improvements in operational performance, timeliness, and experience, while driving efficiency and reducing administrative expense

• Identify end-to-end process improvements throughout the organization designed to create efficiencies and allow us to scale for growth and/or operational requirements, such as increasing automation and adoption of self-service

• Serve as a strategic leader in collaboration with all Health Plan Operations leaders, examining HPO processes and analytics to gain insights to drive short- and long-term planning and strategy

• Provide thought leadership to the Health Plan Operations organization and other cross-functional leaders throughout BSC and Stellarus - employing tools of analysis learned through previous experience in management consulting (or similar within a healthcare enterprise)

• Direct and guide leadership teams in designing and implementing operating plans that deliver on immediate business needs while advancing long-term strategic goals

• Provide executive oversight and leadership to managers responsible for creating and driving implementation of operating plans, which are required to support immediate and long-term requirements and business strategies​

• Define and execute a strategic roadmap to modernize health plan operations, delivering measurable improvements in operational performance, timeliness, and experience, while driving efficiency and reducing administrative expense

• Identify end-to-end process improvements throughout the organization designed to create efficiencies and allow us to scale for growth and/or operational requirements, such as increasing automation and adoption of self-service

• Oversee the swift and successful implementation of improvement ideas, managing a portfolio of projects inclusive of creation of business cases to obtain funding and project delivery - using a small core team and other matrixed resources
• ​​Define and support the implementation of optimal organizational and operational structures, systems and processes to facilitate business performance including operations improvement and regulatory requirements; and ensure optimization of resources by resolving any duplicative improvement efforts and organization structures​ 
• ​​Ensure customer-driven Key Performance Indicators (KPIs) and goals are in place, which are reflective of and measure our strategic, competitive and regulatory position with ongoing measurement, reporting, and root cause analysis​ 
• ​​Maintain tracking and analysis for critical improvements with Return On Investment (ROI), Key Performance Indicators (KPIs) delivery while managing risk for audits both internally and externally​ 

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 10 years prior relevant experience, including 6 years of management experience
• 12 years of prior relevant experience preferred

• Strongly prefers Management Consulting experience - would consider alternate experience executing a transformation agenda in a large-scale health insurance operations team

• Requires in-depth experience in Health Plan and/or Health Care Operations, including areas such as Claims, Appeals and Grievances, Operations, Call Center, and/or Customer Experience.

• Requires experience leading operational teams in a matrixed organization
• Requires exceptional verbal and written communication skills, including an ability to communicate effectively at the executive level
• Requires ability to influence peers and senior executives across functional teams

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.