Director, Operations Performance Office
$134,960–$202,440 year
On-siteMeridian, Idaho, United States
Job Summary
Lead enterprise operational performance management across Claims, Customer Service, Membership, Payment Integrity, and related functions by establishing governance frameworks, KPIs, SLAs, and scorecards. Drive alignment between strategic objectives, regulatory requirements, and customer outcomes while monitoring operational trends, risks, and performance commitments. Oversee quality assurance, compliance monitoring, and vendor performance standards to ensure readiness for audits and regulatory reporting. Develop predictive analytics, forecasting models, and AI-enabled capabilities to improve operational decision support and effectiveness. Build and lead a high-performing team of analytics and performance professionals, fostering a culture of accountability and continuous improvement. Report to the Chief Information & Operations Officer at corporate headquarters in Meridian, Idaho.
Required Qualifications
- Minimum of 10 years' experience in operational analytics and reporting
- At least 5 years in managing teams
- Minimum of 5 years' experience in health plan or managed care operations
- Experience in Claims
- Experience in Customer Service
- Experience in Membership
- Experience in Payment Integrity
- Demonstrated success leading enterprise KPI programs
- Operational governance experience
- Continuous improvement initiatives experience
- Experience managing vendor performance
- Outsourcing relationships experience
- Operational Performance Management skills
- Data Analytics skills
- Reporting skills
- Quality Assurance skills
- Root Cause Analysis skills
- Operational Compliance skills
- Vendor Governance skills
- Lean Six Sigma skills
- Performance Dashboard Development skills
- KPI Framework Design skills
- Communication skills
- Experience with Artificial Intelligence (AI)
- Experience with Generative AI applications
- Experience with Business Intelligence and reporting platforms
- Power BI experience
- Tableau experience
- Ability to translate data
- Predictive analytics ability
- Bachelor's degree in Business
- Bachelor's degree in Healthcare Administration
- Bachelor's degree in Analytics
- Bachelor's degree in a related field
- Equivalent experience to Bachelor's degree
- Two years of relevant work experience equivalent to one year of college
Desired Qualifications
- Master's degree
- Experience with CMS
- Experience with Medicare Advantage Star Ratings
- Experience with NCQA
- Experience with state regulatory requirements
- Experience with healthcare operational compliance programs
- Lean Six Sigma certification (Green Belt or Black Belt)
- PMP certification
- CPHQ certification
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