Director Issue Management

Director Issue Management

The Director defines and leads a multi-tier issue management organization, holding leaders accountable to performance targets for acute issue resolution, and owns the systemic issue pipeline so that recurring and high-impact issues are identified, root-caused, documented, and resolved. This position governs the continuous improvement and visual management system, drives upstream process change with impacted cross-functional stakeholders, serves as the voice of the process in enterprise forums, and reports operational health, KPI performance, issue trends, and outsourced partner performance to enterprise leadership while building organizational capability through coaching, talent development, and succession planning.

Job Summary The Director defines and leads a multi-tier issue management organization, holding leaders accountable to performance targets for acute issue resolution, and owns the systemic issue pipeline so that recurring and high-impact issues are identified, root-caused, documented, and resolved. This position governs the continuous improvement and visual management system, drives upstream process change with impacted cross-functional stakeholders, serves as the voice of the process in enterprise forums, and reports operational health, KPI performance, issue trends, and outsourced partner performance to enterprise leadership while building organizational capability through coaching, talent development, and succession planning.

Key Responsibilities:

Facilitate and lead the strategic planning process for the development, implementation and management of provider servicing/engagement and enablement.

Leads, directs and manages multiple business function areas within functional area ensuring appropriate processes are implemented and value is realized.

Formulate and implement issue management strategies for specific business areas that ensure the financial performance of the enterprise is successful.

Identify and communicate appropriate medical cost management initiatives to support the overall success of financial performance.

Define and lead a multi-tier issue management organization, providing leadership to monitor, and hold leaders accountable to performance targets.

Own the systemic issue pipeline, ensuring recurring and high-impact issues are identified, root-cause, documented, and resolved through issue resolution plans and maintain live backlog of improvement opportunities.

Govern the continuous improvement and visual management system, including daily huddles, tier boards, standard work documentation, and team adherence to process standards.

Drive cross-functional and upstream accountability by translating experience pain points into process action, escalating systemic, and closing upstream process changes with impacted stakeholders.

Serve as the voice of the process in cross-functional forums, representing issue management priorities and ensuring closed-loop accountability for resolution.

Consolidate and report operational health, KPI performance, issue trends, and outsourced partner performance to enterprise leadership.

Build organizational capability and skills through coaching, talent development, and succession planning across supervisory, consulting, and process engineering roles.

Strong knowledge in Commercial and Government market segments health and ancillary products as well as an understanding of compliance requirements.

Key Requirements:

6+ years' related work experience. Defined as experience in health business, compliance and legal background, customer experience management, issue resolution, process improvement.

3+ years' direct supervisory/management experience.

Related Bachelor's degree or additional related equivalent work experience.

Experience developing and executing strategies, business plans, and tactical plans.

Knowledge of operational processes for health insurance business.

Experience in the development and execution of business tactical plans in compliance with laws and regulations.

Preferred:

Experience developing strategies, overseeing work activities, and delivering results across external parties on behalf of an organization.

Demonstrated ability with developing and overseeing project portfolios and process improvement programs to drive improved customer experience.

Experience developing and overseeing effective controls. Proficient in Microsoft Word, Excel, and PowerPoint.

General Physical Demands:
Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).

What We Offer:

As a Florida Blue employee, you will be at the heart of Guide Well's vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living. To support your…