Head of Medicare Hub

Senior Director, Medicare Performance Hub

The Senior Director, Medicare Performance Hub (MPH) is a leadership role within the Blue Cross Blue Shield Association (BCBSA) Medicare business operations team. This individual will serve as the primary programmatic owner and operational lead for the MPH — a core enabling function designed to drive performance improvement in the areas of Star Ratings, Risk Adjustment, and Medical Cost Management. The MPH leader will oversee the build-out, operationalization, and ongoing governance of the Hub, translating national program data and analytic insights into targeted, actionable guidance for Plans.

This role sits at the intersection of analytics, clinical performance, provider performance, plan engagement, and vendor management — requiring a leader who can fluently navigate data-driven strategy while managing complex stakeholder relationships across internal BCBSA teams, Blue Health Intelligence (BHI), analytics platform partners, and the Blue System.

The Hub is designed to provide contract-level performance intelligence and member-level insights that enable Plans to execute local actions that improve Stars performance, coding accuracy, and medical cost outcomes. The MPH does not execute locally — it equips, enables, and holds Plans accountable. Plans retain responsibility for direct member and provider engagement; the MPH provides the intelligence infrastructure and consultative support that makes that engagement effective.

The MPH will:

• Proactively identify benchmarks and performance targets across Stars, Risk Adjustment, and Medical Cost Management
• Monitor performance in real time where data and technology allow, and retrospectively identify gaps and remediation pathways
• Deliver actionable, member-level insights to Plans via dashboards and direct consultative engagement
• Coordinate with analytics platform partners, BHI, and BCBSA clinical and analytic staff to operationalize performance data
• Establish governance and accountability structures, including escalation pathways, corrective action plans, and Plan performance incentive frameworks

Analytics Oversight & Vendor Management

• Serve as the business owner and primary BCBSA liaison for the MPH analytics platform vendor, accountable for program and Plan level performance and deliverables against contract terms
• Partner with the analytics vendor to build management and operational dashboards providing national, regional, and Plan-specific performance views with drill-down capability to provider, geography, and member level
• Collaborate with BHI to develop benchmark and target-setting methodology for the Plan Performance Incentive Program (PIP) across Stars, Medical Cost Management, and Risk Adjustment coding accuracy
• Oversee data integration strategies across key data types — including Parts C and D claims, clinical supplemental data, encounters, and Risk Adjustment Files (RAF) — working across FEPOC, BCBSA IT, and Plan data and analytics leads
• Manage MPH data access and license strategy for Plans, in coordination with BCBSA IT and the analytics vendor
• In coordination with BHI, leverage VRDC, NDW, and other Blue-sourced data to establish program-wide benchmarks and performance targets

Program Leadership & Strategy

• Lead the design, implementation, and ongoing management of the Medicare Performance Hub
• Develop and execute the MPH operating model, including engagement processes with Plans and vendors, business review cadences, best practice sharing, and escalation/remediation protocols
• Establish and manage the MPH governance framework, engaging with Plan CEOs, leadership, BCBSA senior management, and the Board of Managers and Directors as appropriate
• Define and maintain MPH scope — distinguishing national programmatic functions from local Plan responsibilities — and ensure alignment across all stakeholders

Plan Engagement & Oversight

• Serve as the primary BCBSA relationship lead for Plans on MPH performance matters, establishing a cadence of operational reviews, performance reporting, and consultative engagement
• Translate national program insights into Plan-specific action plans; facilitate targeted strategies for Plans requiring…