Premera Blue Cross
Improve customers' lives by making healthcare work better.
Manager, Claims Optimization
Location
Alaska + 26 moreAll locations: Alaska, Arizona, California, Colorado, Florida, Idaho, Iowa, Kansas, Kentucky, Maine, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Michigan, Minnesota, Missouri, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin
Posted
1 day ago
Salary
$118.9K - $202.1K / year
Bachelor Degree5 yrs expExperience acceptedEnglish
Job Description
• Claims Process Optimization & Reengineering Act as the product owner for claims operations to define and execute the claims optimization strategy and roadmap, aligned with operational efficiency and customer experience objectives.
• Own the analysis, redesign, and optimization of end‑to‑end claims processes to improve operational performance.
• Develop and implement process enhancements that reduce manual effort, cycle time, rework, and variation.
• Ensure optimized processes can be consistently executed by production teams at scale.
• AI & Automation Operational Ownership Lead the adoption of AI‑enabled and automated solutions in Claims Operations by defining operational use cases and success criteria.
• Own business rules, decision criteria, and expected outcomes for automated claims workflows.
• Monitor automation performance, accuracy, and exceptions, and partner with enabling teams to address gaps or changes in requirements.
• Implement change management protocols and ensure that automation evolves with workflow and process changes.
• Data, Analytics & Performance Measurement Use operational data, dashboards, and analytics to identify improvement opportunities and quantify benefits.
• Establish and monitor KPIs related to efficiency, quality, cycle time, automation effectiveness, and customer impact.
• Measure performance before and after process changes to validate results and guide prioritization.
• Provide clear, actionable insights to claims leadership to support decision‑making and continuous improvement.
• Operational Governance, Compliance & Risk Ensure claims workflows and optimized processes comply with regulatory, contractual, and policy requirements.
• Partner with Compliance, Legal, and Risk teams to identify and mitigate operational risk Maintain documentation of workflows, decision logic, controls, and optimization changes to support audit readiness.
• Cross-Functional Collaboration Provide operational leadership in discussions related to claims process changes and workflow impacts.
• Translate operational needs into clear requirements and acceptance criteria for enabling teams.
• Partner with Product, Engineering, Configuration, and other enterprise teams to support effective implementation of optimized processes claims workflows.
• Team Leadership Lead and develop a claims optimization team focused on process improvement, automation support, and performance insights.
• Foster a continuous improvement mindset and data‑driven culture within Claims Operations.
• Set clear priorities and expectations aligned to measurable operational outcomes.
Job Requirements
- Bachelor’s degree or four (4) years of relevant work experience (Required).
- Five (5) years of experience in health insurance claims operations or process optimization, with hands-on exposure to workflow improvements or automation (Required).
- Two (2) years of experience leading and managing team(s) of direct reports (Required).
- Experience in Continuous Process Improvement (e.g., Lean or Six Sigma).
Benefits
- Medical, vision, and dental coverage with low employee premiums.
- Voluntary benefit offerings, including pet insurance for paw parents.
- Life and disability insurance.
- Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
- Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
- Generous paid time off to reenergize.
- Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
- Employee recognition program to celebrate anniversaries, team accomplishments, and more.
- For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
- Commuter perks make your trip to work less impactful on the environment and your wallet.
- Free convenient on-site parking.
- Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
- Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
- Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
- Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.