Director, Operations

  • Blue Shield of California
  • Monterey Park, California

Job Description

Director, Operations - 19001CF Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


Director, Claims Operations, Customer Experience and Operations Blue Shield of California Promise Health Plan serves over 500,000 Californians through its Medi-Cal, Cal MediConnect and Medicare programs. The, Claims Operations will direct large-scale, complex programs that will significantly impact operational improvements and end-to-end consumer experience for members and providers. This is a critical, high-visibility role as BSC Promise Health Plan is positioning for growth and market leadership to cover all Californians. Join us if you are also committed to create a healthcare system that is worthy of our family and friends and is sustainably affordable. We are seeking smart individuals who want to positively impact people’s lives. The Director of Claims Operation will be forging critical relationships with our leaders and influencing stakeholders across the Blue Shield of California enterprise to improve customer experience through operational performance and program compliance. S/he will be responsible for convening and leading multi-departmental workgroups to design and execute programs that are well-received, consistently delivered, and achieve expected business outcomes. This individual we be a key a leader in the organization. This position will be based in Monterey Park, CA, and report to the Senior Director of Customer Experience & Operations. The Director of Claims Operations will work with Promise Health Plan and Blue Shield of California executives, regulators, and providers. Responsibilities:Defines and establishes key performance indicators which are reflective of and measure Blue Shield of California’s competitive position relative to service delivery. Ensures that performance objectives and outcomes are consistent with external and internal customer expectations and meet competitive benchmarks; routinely integrates customer feedback and competitive information into ongoing planning and operational activities. Serve as a subject matter expert to regularly brief key stakeholders on different aspects of assigned initiatives. Leads relationship management with cross-functional leaders across the enterprise, and manages cross-functional operational linkages to ensure end to end business processes surrounding operational areas meet customer and stakeholder requirements Partner with business sponsors to define success metrics and criteria. Managing the workload between Promise Health Plan and its vendors Coordinate internal and external communications and policies using quantitative and qualitative analysis Work closely with our provider organization and providers to resolve issues and improve business practices. Fosters a great place to work by clearly defining mission, vision, goals, roles, and expectations for team members; recognizing top talent and team achievements; building successful working relationships across the organization Other duties as assigned.




: Bachelor’s degree in Business Administration, Healthcare Administration, or Public Policy, with a minimum of 10 years’ prior relevant experience, including 6 years of management experience. Candidate should have at least 5 years working with Med-Cal and/or Medi-Caid programs for a health plan, government agency or consulting firm, or 10 years equivalent and progressive Medi-Cal work experience. 8+ years experience leading projects and interacting, regulators, internal auditors, providers, and peer organizations 5 years experience managing vendors, including contract negotiations and setting quality standards Compelling negotiation skills and proven compliant resolution experience Medi-Cal research and contract administration experience Demonstrated ability to interact with Senior Management and peers on matters requiring internal or cross-company coordination and solutioning. Preferred


: Masters degree in Healthcare administration, or Public Policy, or MBA Experience processing claims in the Facets Processing Systems Lean Six Sigma training and/or project management certification or experience. Experience Building financial budgets and economic analysis Knowledge / Skills / Abilities: Must be an organized and analytical thinker with the ability to apply organizational strategies to Customer Experience programs. Needs to be results-oriented and can prioritize and manage competing priorities. Should have a strong background in data analysis, problem solving, and managing resources Engage and Inspire; Foster Open Communication; Establish Plans; Manage and Improve Processes; Build Relationships; Physical


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. Please click here for further physical requirement detail.

Operations and Management

Primary Location:
United States of America-California-Monterey Park