Director, Strategic Planning and Performance

This role is part of the Health Plan Operations (HPO) team, providing operational support to Blue Shield of California. The Director of Health Plan Operations Optimization will report to the Vice President of Health Plan Operations and drive an efficient operating model that delivers outcomes worthy of our family and friends. You will lead strategic initiatives to improve performance, stakeholder satisfaction, process efficiency, and cost reduction across HPO teams in Customer Experience, Claims, Healthcare Business Operations, and end-to-end Backoffice operations. This includes hands-on analysis of key performance issues and solution identification.

Our leadership model focuses on developing great leaders at all levels, fostering growth—personally, professionally, and financially. We seek leaders energized by creative and critical thinking, building high-performing teams, achieving results ethically, and promoting continuous learning.

Responsibilities

• Serve as a strategic leader in collaboration with all Health Plan Operations leaders, examining HPO processes and analytics to drive short- and long-term planning and strategy.
• Provide thought leadership to the Health Plan Operations organization and cross-functional leaders, employing analytical tools from management consulting or similar healthcare enterprise experience.
• Direct and guide leadership teams in designing and implementing operating plans that address immediate business needs while advancing long-term strategic goals.
• Provide executive oversight to managers responsible for creating and implementing operating plans to support business strategies.
• Define and execute a strategic roadmap to modernize health plan operations, delivering measurable improvements in performance, timeliness, experience, efficiency, and cost reduction.
• Identify end-to-end process improvements to create efficiencies, scale for growth, and meet operational requirements, such as increasing automation and self-service adoption.
• Oversee the implementation of improvement ideas, managing a portfolio of projects, including business case development for funding and project delivery using a small core team and matrixed resources.
• Define and support optimal organizational and operational structures, systems, and processes to enhance business performance, including operations improvement and regulatory compliance; resolve duplicative efforts and structures.
• Ensure customer-driven Key Performance Indicators (KPIs) and goals are in place, reflecting strategic, competitive, and regulatory positions, with ongoing measurement, reporting, and root cause analysis.
• Maintain tracking and analysis of critical improvements with Return on Investment (ROI) and KPI delivery while managing audit risks internally and externally.

Qualifications

• Bachelor’s degree or equivalent experience.
• At least 10 years of relevant experience, including 6 years of management experience; 12 years preferred.
• Management consulting experience strongly preferred; alternate experience executing transformation agendas in large-scale health insurance operations considered.
• In-depth experience in Health Plan and/or Healthcare Operations, including areas such as Claims, Appeals and Grievances, Operations, Call Center, and/or Customer Experience.
• Experience leading operational teams in a matrixed organization.
• Exceptional verbal and written communication skills, including the ability to communicate effectively at the executive level.
• Ability to influence peers and senior executives across functional teams.

Schedule

This role follows a hybrid workplace model, requiring in-office presence two days per 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.

Pay

• California: $181,830.00 to $272,800.00
• Bay Area: $204,972.00 to $307,520.00

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun, a nonprofit parent organization that includes Blue Shield of California, Blue Shield of California Promise Health Plan, Altais (a clinical services company), and Stellarus (a company scaling healthcare solutions). Together, these entities form the Ascendiun Family of Companies.

Blue Shield of California’s mission is to create a healthcare system worthy of our family and friends—sustainably affordable, transforming healthcare to lower costs, improve quality, and enhance member and physician experiences. We foster an inclusive workplace where all employees can thrive and contribute to addressing community needs. Recognized as a U.S. News Best Company to Work For, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace, Blue Shield has also been acknowledged by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the U.S.

Our values: Honest (highest ethical and integrity standards), Human (effective communication and empathy), and Courageous (standing up for beliefs and committing to ambitious goals).