Head of Medicare Performance Hub

Blue Cross Blue Shield Association

. Serve as the primary programmatic owner and operational lead for the Medicare Performance Hub .

Posted 9/16/2026full-timeChicago • California • United StatesLead💰 $198,175 - $278,053 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage program management, focusing on performance improvement in Star Ratings, Risk Adjustment, and Medical Cost Management. Proficient in translating data insights into actionable guidance and managing complex, multi-stakeholder programs.

Highest-signal resume keywords

Medicare Advantage Program ManagementCMS Star RatingsRisk Adjustment/HCC Coding AccuracyMedical Cost ManagementManaged Care Performance Analytics

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisPerformance Improvement StrategiesProject ManagementDashboard DevelopmentBenchmarking Methodology

Soft Skills

Excellent Communication SkillsStakeholder EngagementConsultative Engagement

Tools & Technologies

Analytics PlatformsData Integration ToolsCMS Reporting Systems

Certifications & Qualifications

BS or Equivalent ExperienceMS in Health Administration (Preferred)

Industry Keywords

Medicare AdvantageHealth Plan OperationsManaged CareCMS RegulationsCompliance Standards

About the role

Key responsibilities & impact

Serve as the primary programmatic owner and operational lead for the Medicare Performance Hub
Drive performance improvement in Star Ratings, Risk Adjustment, and Medical Cost Management
Oversee the Hub’s build-out, operationalization, and ongoing governance
Translate national program data and analytic insights into targeted guidance for Plans
Identify benchmarks and performance targets across Stars, Risk Adjustment, and Medical Cost Management
Monitor performance in real time where possible and identify gaps and remediation pathways
Deliver member-level insights to Plans through dashboards and consultative engagement
Coordinate with analytics platform partners, BHI, and BCBSA clinical and analytic staff
Establish governance, escalation pathways, corrective action plans, and Plan performance incentive frameworks
Own the MPH analytics platform vendor relationship and accountability for program and Plan-level deliverables
Build dashboards with national, regional, Plan, provider, geography, and member-level views
Develop benchmark and target-setting methodology for the Plan Performance Incentive Program
Oversee integration of claims, clinical supplemental data, encounters, and Risk Adjustment Files
Manage MPH data access and licensing strategy for Plans
Lead design, implementation, operating model, and governance of the Medicare Performance Hub
Establish operational reviews, reporting cadences, best-practice sharing, and escalation/remediation protocols
Engage Plan CEOs, senior management, Board of Managers and Directors, CFOs, Government Business Leaders, FEP leads, and clinical and analytic staff
Translate national insights into Plan-specific action plans and facilitate performance improvement strategies
Monitor Stars performance, develop Stars analytics, and support HEDIS, administrative, and Part D measure improvement
Develop risk adjustment analytics covering encounter submissions, chart review, HRA performance, coding opportunities, supplemental clinical data, and RAF trends
Lead medical cost management analytics covering readmissions, ED utilization, high-cost claimants, inpatient and post-acute utilization, and other cost drivers
Develop and maintain the medical cost performance playbook
Partner with Plans on cost trends, root causes, targeted interventions, and local vendor engagement
Define MPH data requirements and represent MPH needs in data architecture decisions
Ensure analytics requirements align with MA data repository architecture and Plan submission standards
Coordinate with Legal, Compliance, and Actuarial functions to align operations, data sharing, and incentives with CMS regulations, BCBSA policy, and the PPA

Requirements

What you’ll need

BS or equivalent experience
12+ years of experience in Medicare Advantage program management, health plan operations, or managed care performance improvement
Demonstrated expertise in at least two of: CMS Star Ratings, Risk Adjustment/HCC coding accuracy, or Medical Cost Management
Experience managing complex, multi-stakeholder programs involving health plans, analytic vendors, and a national program office function
Deep understanding of Medicare Advantage data flows, including Parts C and D claims, supplemental clinical data, encounter data, and CMS reporting requirements
Experience with managed care performance analytics and data-driven plan engagement
Ability to translate data insights into actionable, plan-level guidance
Strong project management skills managing multiple parallel workstreams across internal and external teams
Excellent written and verbal communication skills
Track record presenting complex analytic and operational information to executive audiences
Preferred: MS in Health Administration, Public Health, Business Administration, or a related field
Preferred: Experience within or supporting a national Blue plan program, EGWP, or FEP
Preferred: Familiarity with Medicare Advantage analytics platforms, multi-source data integration, and CMS administrative data benchmarking, including VRDC, MMR, and NDW
Preferred: Experience managing health analytics vendor relationships, including contract oversight and deliverable accountability
Preferred: Knowledge of CMS audit, compliance, and reporting requirements applicable to Medicare Advantage plan sponsors

Benefits

Comp & perks

Annual bonus incentive pay
Paid time off
11 holidays
Medical insurance
Dental insurance
Vision insurance
Generous 401(k) matching
Lifestyle spending account
Comprehensive package of benefits for eligible employees