Director, Strategic Planning and Performance

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.

ABOUT THE TEAM

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities -- join us!

Our Values:

• **Honest.**We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• **Human.**We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• **Courageous.**We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.

• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.