Director, Operations Programs and Implementation

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

• Directs and leads integrated customer service, claims, and member services units to achieve performance goals and operating efficiencies. Manages staff, workload, and budgets. Removes barriers to individual and group performance through the discovery and implementation of process improvements.
• Collaborate with other Blue KC departments to effectively oversee projects, identify resources, resolve issues and mitigate risks
• Facilitate new business integration
• Develop and implement plans to identify root causes and actions necessary to resolve identified operational issues
• Facilitate development of various reporting tools to monitor operational functions and identify opportunities for improved performance, including development and analysis of reports
• Adheres to corporate, association, governmental, and other governing body requirements, including but not limited to MTM, IPP, FEP, Inter-plan standards, and other measures of performance and compliance. Meets timeliness and accuracy expectations.
• Supports efforts to market BlueKC products and services. Ensures that company can meet commitments to customers, and/or enables Marketing to offer higher levels of service to groups and individuals. Finds ways to better compete in the market through the adoption of operating efficiencies. Responds to RFI's. Speaks to groups, including at final presentations, to explain company operations and processes
• Supports efforts to retain customers and groups. Participates on or leads quality management teams who meet with existing groups to ensure service levels and address service issues. Contacts members or group representatives to discuss major concerns.
• Manages the Group Services unit and ensures procedures are in place to correctly load benefits and configure FACETS for optimal efficiency and accuracy.
• May manage and direct special functions and groups not common to all director positions. Some of these include claims recovery; call centers; MSP/COB support; central operations; Blue Card/IPP; joint account administration; Group 25; dedicated enrollment and billing units; MA and ACA operations, dedicated claims and customer service units.
• Engages in working relationships with representatives of other plans to handle inter-plan claims issues and seek problem resolution.
• Acts as business sponsor for projects/programs with operations teams impact
• Represents the Operations division on various corporate committees and work groups and provides input for projects, process improvements, and problem resolution.

Minimum Qualifications

• Bachelor's degree in business or other relevant academic discipline or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job.
• 7 years of experience, with a minimum of 5 years experience in a management, supervisory, leadership or project leadership role, 3 of those years in a claims, customer service, or other service management role
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or governmental regulations.
• Ability to effectively present information to top management, public groups and/or boards of directors.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of technical materials and deal with several abstract and concrete variables.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to lead, guide, motivate, and direct the work of others
• Intermediate knowledge and skills using Microsoft Word, Excel, Access, and PowerPoint, or similar PC-based software.
• Intermediate experience using Facets and/or NASCO.
• Thorough knowledge of service operations in a managed care setting

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.