Premera Blue Cross

Manager, Claims Optimization

Premera Blue Cross

full-time

Posted on:

Location Type: Remote

Location: Alaska • Arizona • United States

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Salary

💰 $118,900 - $202,100 per year

About the role

  • 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.

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.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
claims process optimizationprocess reengineeringAI-enabled solutionsautomationdata analyticsKPI measurementworkflow improvementcontinuous process improvementLeanSix Sigma
Soft Skills
leadershipcross-functional collaborationchange managementcommunicationteam developmentproblem-solvingdecision-makingorganizational skillscontinuous improvement mindsetdata-driven culture