Premera Blue Cross

Role Description The Care Coordinator - Retrospective performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. The incumbent partners with Medical Directors and other Premera Departments such as FEP, National Account Liaisons, Health Care Services and Claims to ensure appropriate cost-effective care by applying their clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, benefit application and provider out of network requests. This work is done for all lines of business and all geographic regions. - Performs medical necessity review that includes inpatient review, concurrent review, benefit advisory/prior authorization, retrospective, out of network, and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and contracts. - Consults with Medical Directors when care does not meet applicable criteria or medical policies. - Documents clinical information completely, accurately, and in a timely manner. - Meets or exceeds production and quality metrics. - Maintains a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria including Milliman Care Guidelines and medical policy. - Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g., case management, engagement team, and disease management). - Collaborates, educates, and consults with Customer Service/Claims Operations, Sales and Marketing and Health Care Services to ensure consistent work processes and procedural application of clinical criteria. - Maintains a thorough understanding of accreditation and regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards are within compliance. - Supports the Plan's Quality Program: Identifies and participates in quality improvement activities as it relates to internal programs, processes studies and projects. Qualifications - Bachelor's degree or four (4) years’ work experience (Required) - Current State Licensure as a registered nurse (Required) - Three (3) years of clinical experience (Required) - Utilization Management experience (Preferred) - Experience working in the health plan industry (Preferred) Requirements - Play a key role in improving healthcare outcomes and ensuring the judicious use of resources. - Join a team of professionals dedicated to ensuring the highest quality of care while managing utilization effectively. - Influence critical decisions that impact patient care and organizational efficiency. - Opportunities for ongoing learning and career development in the ever-changing field of healthcare. 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - 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. - Complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. - Challenge someone to a game of shuffleboard or ping pong while on campus.

Role Description As a Clinical Pharmacist, you’ll help shape and advance clinical pharmacy programs that drive safe, clinically appropriate, and cost‑effective medication use. You’ll use data and evidence-based insights to influence pharmacy strategy, partner closely with Pharmacy leadership, and turn recommendations into programs that make a measurable difference. In this role, you’ll also support key drug utilization management initiatives across Pharmacy, Medical Services, Care Management, Case Management, Disease Management, and HEDIS clinical quality measures. - Support medical management and clinical pharmacy initiatives of Premera companies in support of commercial and government lines of business through research, analyses, and administration of clinical drug utilization management programs. - Provide clinical drug utilization management, formulary management, and business support to key internal and external stakeholders. - Support and assist in administering Pharmacy Prior Authorization and other clinical pharmacy programs. - Provide and develop clinical drug information support to stakeholders across the company through writing, researching clinical cases and standard of care algorithms needed to deliver key pharmacy messages. - Perform drug/medication therapy management services to support the management of drug utilization on the medical benefit, including case and disease management. - Identify and help resolve drug-related issues/problems in concert with medical services staff (medical directors, case managers and disease managers) to optimize medication therapy and to improve clinical outcomes. - Assist case managers in identifying and eliminating barriers to care. Provide Personal Medication List (PML) through comprehensive medication reconciliation, patient-specific Medication Action Plan (MAP) and written/verbal communication and feedback to healthcare providers. - Help design drug therapy components of disease management algorithms. - Recommend appropriate interventions to meet accreditation requirements (NCQA, HEDIS, etc.). - Assist in developing medical policies for drug utilization management programs. - Support the Specialty Pharmacy management program by recommending solutions to improve Specialty drug therapy management for high cost and complex drugs. - Assist Pharmacy leadership in analyzing and researching pharmacy cost trends and clinical program opportunities. - May provide consultative services to large and mid-size employer groups regarding pharmacy benefits, trends and strategic direction appropriate for their employee population. - May educate account managers, producers and clients about pharmacy programs and benefits. - Assist in developing and maintaining provider and member communication materials that support clinical pharmacy programs. - Support and serve as a preceptor for pharmacy students and/or residents, introducing them to drug utilization management, care management activities product review and program development. - Perform other duties as assigned. Qualifications - Bachelor’s degree in Pharmacy. (Required) - A Washington State pharmacist license. (Required) - Active US Pharmacist license in good standing. - Two (2) years’ experience as a pharmacist. (Required) - An advanced degree (e.g. PharmD, MBA, MHA, MPH or equivalent experience). (Preferred) - Clinical pharmacy training, clinical residency training from an accredited Pharmacy program. (Preferred) - Experience in managed care/payor setting. (Preferred) - Experience working in a retail pharmacy or hospital environment. (Preferred) - Demonstrated knowledge of drug utilization management tactics including formulary development and drug use criteria development. - Demonstrated knowledge of drug information procedures and reference sourcing. - Ability to support multiple, complex, and concurrent projects. - Strong organizational and planning skills. - Ability to effectively communicate both orally and in writing. - Strong interpersonal and relationship building skills. - Ability to work independently, as well as a member of a team. - Strong analytical and PC operation skills (i.e. Microsoft Office products). - Familiarity with local and regional health care issues. 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - On-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. - Commuter perks to make your trip to work less impactful on the environment and your wallet. - Free convenient on-site parking. - Subsidized on-campus cafes for affordable lunchtime connections with colleagues. - Engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs, and more. - Complementary fitness & well-being center offering both in-person and virtual workouts and nutritional counseling. - Game options like shuffleboard or ping pong for a brain break on campus.

Role Description As an AI Engineer III, you will work within a team responsible for taking AI/ML solutions from initial concept to full production implementation. This role requires creativity and analytical skills to understand business challenges, propose AI-enabled solutions, and bring them to life through robust system design, modeling, and coding. You will collaborate cross-functionally to ideate and prototype new AI products. Your models, architectures, and software contributions will power innovative AI systems that solve complex problems at scale. To excel in this role, you will need hands-on experience rapidly developing and deploying ML algorithms alongside strong software engineering abilities to build reliable and maintainable AI infrastructure. This is a remote/telecommuter position, working from home. What you’ll do: - Develop comprehensive systems and frameworks for AI applications and products. - Construct prototypes and minimum viable products to validate AI/ML solutions before committing substantial resources. - Develop, refine, and productionize AI systems using cloud resources such as Azure OpenAI, Azure ML, and Cognitive Services. - Contribute to the creation of robust data pipelines for model evolution and production systems. - Develop specifications for low latency APIs and services necessary to deploy AI models and incorporate them into applications. - Supervise and sustain AI systems in production to guarantee consistent model accuracy and reliability. - Actively participate in a team that exercises principled, agile-like development practices. - Create and maintain thorough documentation that is consistent with team procedures, corporate policies, and expectations. - Ensure peer review on all assigned work, as well as conduct peer reviews over the work of others as requested. - Guide junior AI engineers on AI/ML and industry best practices and methodologies. - Keep abreast of new tools and concepts through reading documentation or literature and actively practicing skills development. - Support and participate in meetings with external stakeholders. Qualifications - Bachelor's Degree in Computer Science, Statistics, Mathematics, or a related field, or 2+ years of experience in a related, professional IT/analytics position. - Minimum of 3 years of industry experience in developing, deploying, and maintaining AI or ML systems. Up to two years of industry experience may be substituted with an AI centered Master’s/PhD or AI Engineering certifications. Requirements - At least 4 years of experience in developing deep learning models using TensorFlow, PyTorch, MLX, JAX, or other modern deep learning frameworks. - Knowledge of and experience in implementing ethical AI practices, with at least 2 years spent working on projects that require explainable AI, fairness, and bias mitigation. - Minimum of 3 years of proficiency in utilizing advanced prompt engineering techniques like General Knowledge Prompting and ReAct. - Minimum of 3 years of experience in successfully productionizing AI models, including constructing scalable data pipelines and establishing robust monitoring systems. - 3 or more years working within Agile-like teams and environments. 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - Commuter perks and free convenient on-site parking. - Subsidized on-campus cafes and engaging on-site activities. - Access to a complementary fitness & well-being center offering both in-person and virtual workouts. Equal Employment Opportunity/Affirmative Action Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. Salary Information The salary range for this role is posted below; we generally target up to and around the midpoint of the range. - National Salary Range: $118,900.00 - $202,100.00 - National Plus Salary Range: $135,600.00 - $230,500.00 We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all.

• Represent business within Agile delivery team; develop and retain strong positive relationships with business stakeholders; demonstrate deep expertise of aligned business domain, including knowledge of stakeholders, business and technology strategies; act as liaison with business stakeholders, planning, conducting and leading the analysis efforts for new system implementations as well as system upgrades and maintenance; may lead collaborative decomposition sessions to identify high level scope of work across business and IT areas. • Collaborate with business partners, IT partners and delivery teams on more complex business challenges to identify, refine and document business requirements in the form of epics, features and user stories with clear acceptance criteria or in the form of user cases, business requirements, functional requirements, UI specifications and business rules; consider inter-related solutions when identifying business requirements; understand process analysis and cost versus benefit analysis; and apply these skills routinely; follow industry standard methodologies and guidelines to write technical and support documentation; use wide range of techniques including interviews, document analysis, requirements workshops, business process analysis, use case, story mapping, and task and workflow analysis; develop and maintain knowledge of Premera IT systems within the aligned domain as well as supporting business and IT domains; research, inform and recommend opportunities to apply business and technology solutions to address business problems. • Demonstrates strong knowledge of data considerations for assigned domain and data extract and transport tools; create queries to troubleshoot, develop metrics, and create ad hoc reporting as needed; aggregate, track, analyze and generate reports; perform data analysis to assist in defining functional requirements; develop more complex data mapping and begin to independently create modeling, and data transformation rules. • May participate in multiple testing efforts through the SDLC; builds test scenarios and analyzes data from tests; work with software developer to write test scripts; use data extract tools to validate test results; may provide direction and support for UAT. • Provide input on backlog priorities and dependencies. • Identify and lead improvement opportunities through analysis and understanding of business domain and technology solutions; provide mentorship and direction to more junior analysts within the team; collaborate with delivery team to continuously improve both the team and the solution. • Perform other duties as assigned.

Role Description Join Our Team: Do Meaningful Work and Improve People’s Lives. Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Case Managers are a dedicated team of clinicians (RNs, behavioral health professionals, and dieticians) who utilize a holistic model that enables our members to transition towards healthier lifestyles. Who we serve: - Premera Blue Cross, a nationally recognized leader in the practice of integrated case management, is looking to expand our growing team of Case Managers. - Our comprehensive, whole-person health assessment helps to identify member actionable barriers and develop obtainable goals that will eventually lead to self-care. - Case managers employ an integrated case management approach that recognizes making lifestyle changes is not simple and meets members where they are. - We monitor progress toward goals and facilitate the coordination of providers as needed. - Our market-differentiated approach has helped thousands of members make meaningful improvements to their daily habits, health, and overall well-being. What you will get in this role: - The opportunity to help members in a meaningful and impactful way. - The opportunity to learn and grow. - The opportunity to have an impact. - The opportunity to thrive in a career. - The opportunity to take pride. What you will do: - Engage target members (those who are facing medical, mental health and/or substance utilization disorders) and build a relationship that will support open and constructive dialog on sensitive topics. - Conduct initial holistic health assessments that help build an understanding of a member’s specific situation and needs and identify any social determinants of health (SDOH) and cultural influences that may impact potential lifestyle changes. - Create a space where a case manager and member can collaborate, along with relevant caregivers and providers, to develop a member-centric case management plan that sets goals, addresses potential barriers, and leads to improved health outcomes. - Monitor, evaluate, and update the effectiveness of the member's case management plan to ensure progress toward goals is being made and that current goals remain pertinent. - Facilitate communication and coordination among the health care team to maximize delivery of appropriate care. - Provide interventions focused on removing barriers, promoting positive behavior change using motivational interviewing techniques, and stabilizing the members’ natural support systems by ensuring that caregiver needs are identified and being met. - Maintain concise, accurate, and timely documentation that meets accreditation, contractual, and legal requirements. Qualifications - Active WA State or Compact License in one of the following: - Nursing: Current registration as a nurse (e.g., RN, ARNP) - Behavioral Health: Valid licensure (e.g., LMFT, LICSW, LMHC) - Psychology: Board certification - 3 years' experience with direct patient/clinical care post-licensure. - High-speed cable, DSL, or Fiberoptic Internet, no less than 75 Mbps Requirements - 1+ years prior experience as a Case Manager (preferred) - Certified Case Manager (CCM) certification (preferred) - Chemical Dependency Professional (CDP) (preferred) - Chronic Care Professional certification (CCP) (preferred) - LEAN training (preferred) - Advanced Motivational Interviewing skills (preferred) 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - Commuter perks and free convenient on-site parking. - Subsidized on-campus cafes. - Engaging on-site activities such as health and wellness events. - Complementary fitness & well-being center offering both in-person and virtual workouts.

Role Description As the Assistant Medical Director, you will provide benefit coverage determinations based on medical necessity and contract language for health plan members, including a review of clinical documentation using medical policy criteria, guidelines, and member contracts at Premera Blue Cross. The Assistant Medical Director supports clinical programs (disease and case management), and the review and adoption of health plan developed review criteria. What you will do: - Perform clinical review of various case types as assigned, including pre-service, post-service, and concurrent behavioral health services. - Consult with clinical staff on specific case reviews. - Act as the final decision maker for coverage decisions based on medical necessity, investigational status, other contractual exclusion, or network structure. - Support the peer-to-peer discussion process by communicating with external physicians and providers about denial determinations. - Consult with nursing and other clinical staff to assess and explore care options for members enrolled. - Participate in the development, annual review, and approval of company medical review criteria as a Premera Medical Policy Committee member. - Participate in Inter-Rater Reliability evaluations to ensure consistency in clinical decision-making. - Respond in a professional manner to all requests for consultation from within Premera Blue Cross and from contracted practitioners and facilities. - Support member and provider appeals by participating in the appeals process and conducting secondary reviews as needed. - Fulfill all professional continuing education requirements and participate in ongoing education/training as appropriate. This role will be part-time, 20 hours a week. Qualifications - Licensed Physician with an MD or DO degree (Required) - Unrestricted Washington MD or Alaska DO state licensure, or ability to obtain within 90 days. - Current board certification in psychiatry from the American Board of Psychiatry and Neurology. - Five (5) years of clinical experience in psychiatry (Required) - Previous experience performing medical necessity and clinical reviews in a health plan setting. (Preferred) - Familiarity or experience with clinical criteria sets and clinical pathways, such as MCG (Milliman Care Guidelines) or InterQual. (Preferred) - Familiarity or experience with CPT, ICD, and HCPCS code sets and resource-based relative value scale (RBRVS) pricing concepts. (Preferred) 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - On-campus model provides flexibility with access to on-site resources, networking opportunities, and team engagement. - Commuter perks to make your trip to work less impactful on the environment and your wallet. - Free convenient on-site parking. - Subsidized on-campus cafes for affordable lunchtime connections. - Engaging on-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs. - Complementary fitness & well-being center offering in-person and virtual workouts and nutritional counseling. - Games like shuffleboard or ping pong available on campus for breaks. Company Description Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. We are currently hiring an Individual Enrollment Oversight and Quality Specialist. This position will perform moderate to complex enrollment, eligibility, billing changes and reconciliation, and account research using a variety of methods, systems and platforms. This role is expected to have exceptional customer service skills and interact with internal and external customers in a timely and professional manner via phone, email or written correspondence within established department turnaround times. Must be able to thoroughly explain administrative and regulatory guidelines, their impact and offer alternatives to our members/agents. This position will provide support and coordination to assist in the management and improvement of assigned audit processes. This role will include the development, maintenance and tracking of related audits, procedures, and efficiency work in team and as it relates to our strategic implementation partners. What you will do: - Responsible for reviewing plan provisions and applying specific rules inherent to Individual or Group enrollment scenarios. Apply contractual, state and federal guidelines as appropriate, ensuring work is in compliance with federal and state regulations. - Provide technical support to assigned teams/strategic implementation partners by researching and/or troubleshooting issues related to processing, system, and software applications. - Serve as a resource for customers by researching complex systems issues impacting member eligibility and determining appropriate course of action. Escalate issues or concerns to ensure desired results. - Conduct performance audits to ensure transaction compliance, accuracy and timeliness. Identify, recommend and implement process improvements. - Represent department on cross-functional teams and meet with external customers as required. - Regularly review procedures and training material for in-team and strategic implementation partner training, through partnership with the training and quality coaching teams, to outline and implement improvements for increased efficiency. - Provide back-up and peak-load assistance across Enrollment & Billing as needed; complete special projects and perform other duties as assigned. - Track, monitor, update, and follow-up with strategic implementation partner on audit findings, action plans, and information requests to ensure each item on the action plan is completed in a timely and accurate manner. - Process plan changes, dependent add-ons, direct transfers, transfer accumulators and more challenging types of enrollments. Update eligibility, enrollment and/or billing of accounts. - Contact customers or Producer agents for enrollment clarification and/or to provide administrative/regulatory guidelines. This may include creating written correspondence regarding complex billing and enrollment issues. - Meet or exceed department production and quality standards and remain current on company/departmental policies and procedures. - Educate agents and members on general membership and billing processes and administrative rules; may include Web portal usage and contract or regulation interpretation. - Perform other duties as assigned. What you will bring: - High School diploma or GED. (Required) - Minimum of two (2) years of accounting/finance/bookkeeping experience or two (2) years enrollment processing experience. (Required) - Associate’s degree in accounting. (Preferred) - Previous customer service experience. (Preferred) - Health or insurance industry experience. (Preferred) What you will gain: - Deepen expertise in enrollment, eligibility, billing, and reconciliation by working through moderate-to-complex scenarios across multiple systems and platforms. - Build strong audit and process-improvement skills through developing, tracking, and supporting audits and related procedures to improve quality and efficiency. - Strengthen customer service and communication capabilities by explaining administrative/regulatory guidelines clearly and partnering with internal teams and external customers/agents. Physical Requirements: The following have been identified as essential physical requirements of this job and must be performed with or without accommodation: - This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. - This role requires the ability to use a keyboard and to communicate clearly and understandably in person and over the telephone. Premera total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: - 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. Equal employment opportunity/affirmative action: Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin. The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. National Salary Range: $41,500.00 - $62,300.00 National Plus Salary Range: $47,400.00 - $71,100.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.

Role Description As a Quality Specialist II, you will be responsible for overseeing Premera's compliance with corporate audit programs such as the Blue Cross Blue Shield Association (BCBSA) Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and the Federal Employee Program (FEP) audit, along with ensuring compliance with state and federal laws, contracts, and the achievement of corporate objectives. You will perform daily examination and verification of Premera transactions, such as claims processing, customer inquiries, group and member enrollment, and electronic data exchange. You will also monitor all quality standards for selected claims, inquiries, enrollments, and/or electronic transactions for accuracy, completeness, and timeliness to judge the degree of adherence to the criteria set forth by the BCBSA, FEP, and corporate policy requirements. You will work in conjunction with stakeholders to identify opportunities for quality improvement throughout the company. This is a virtual/remote position, working from home. What you’ll do: - Conduct audits in a professional, ethical, and objective manner using and interpreting applicable standards/requirements. - Effectively plan, develop, and communicate an audit within a defined scope, including resource scheduling. Conduct necessary meetings in performance of the audit. - Maintain in-depth working knowledge of procedural changes, audit techniques, and plan automated systems, subsystems, and reference materials for assigned audit functions. - Responsible for a wide variety of quality auditing tools and techniques. Verify, document, and communicate audit results, develop an audit report, and evaluate the effectiveness of corrective action/follow-up. - Resolve conflict directly and respectfully, engaging in challenging and important conversations to resolve audit findings. - Identify trends and the root cause of errors and recommend improved procedures/guidelines to Operations proactively. - Assist in consulting with external departments to help resolve high impact key business issues surrounding quality assurance. - Help individuals and the team become stronger by actively participating, leading, and facilitating team meetings and workgroups regarding Quality Review and Reporting initiatives and incentives. - Understand quality principles as they relate to business processes and explain the importance of aligning the audit function to the organization. Qualifications - High School Diploma or GED. (Required) - 3 years of claims, customer service, or enrollment work experience, which includes 1 year of quality audit, quality control, or quality assurance experience. (Required) - Demonstrated skills in Microsoft Office Suite: Outlook, Access, Word, Excel, and PowerPoint. - A critical thinker with demonstrated natural curiosity to understand how things work and approach problems in a consistent and systematic way. - Strong analytical skills - demonstrated ability to collect, assimilate, synthesize data using various data collection techniques and validating accuracy. - Strong problem solving skills - demonstrated ability to solve a variety of complex problems in the absence of technical guidelines or precedents. - Proven ability to use effective negotiation techniques to resolve disputes in a tactful and respectful manner. - Ability to manage change and have a pro-active approach to work. - Strong presentation, written and communication skills and ability to communicate effectively with all levels of management. - Highly adaptable and motivated employee. - Listens carefully to fully understand opposing viewpoints, assuming good intent. 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - For 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. Equal Employment Opportunity/Affirmative Action Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is: - National Salary Range: $48,400.00 - $72,600.00 - National Plus Salary Range: $55,200.00 - $82,800.00 (used in higher cost of labor markets including Western Washington and Alaska) We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.

Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. Step into a role where your leadership directly shapes meaningful experiences for the members we serve. As an Enrollment and Billing Team Lead, Operations, you’ll guide a high‑performing team through a fast‑paced and evolving environment—ensuring every interaction reflects our commitment to exceptional service and operational excellence. This is more than a leadership position; it’s an opportunity to inspire, empower, and elevate a team whose work directly impacts the well‑being and satisfaction of our members. If you’re passionate about leading people, improving processes, and driving solutions that make a real difference, this is the place where your leadership truly matters. The E&B Team Lead Operations oversees the workload and performance of assigned staff to support company strategies and operational goals. Key responsibilities include leading the team through a fast-paced, ever-changing environment while monitoring and supporting individual and team performance. This role is also responsible for identifying and implementing effective solutions to problems as they arise. Job Responsibilities - Ensure adequate staffing to meet production and quality standards. - Continuously improve team accuracy, workload capacity, and process efficiency. - Manage and mentor staff; develop measurable departmental and individual goals that support the execution and success of company strategies and guides staff on their individual development plans. Conduct performance evaluations, create performance improvement plans, and recommend merit and promotional increases. - Ensure the completion of appropriate Premera training programs to develop employee knowledge and skills. Recommend and arrange additional training when appropriate. - Manage efficient workflow processes and procedures by maintaining understanding of current workforce management technologies. Monitor service indicators and internal /external customer feedback to design, recommend and implement operational and systems changes. - Analyze and recommend solutions involving systems performance, audits, cost efficiencies, workflow measures, and service trends. Proactively anticipate the impact of the changing business environment on assigned work areas and adjust work assignments and processes as necessary. - Develop and prepare tools, matrices, action plans, procedural manuals, regular and ad-hoc reports to clearly communicate progress on recommendations. - Serve as a resource for and collaborates with cross-functional teams to evaluate and ensure workflow issues are addressed by establishing protocols and developing action plans. Build and maintain cross-functional business relationships across the organization. Lead work teams designed to identify and implement process improvements through LEAN methodologies. Evaluate and provide recommendations to leaders for process improvements based on observations of trends, progress, and obstacles. - Suggest strategies and develop tactical plans that support the overall long-term vision of the department. Serve as an escalation point for direction and strategy for resolution of highly visible complaints and issues. - Manage assigned team including hiring, coaching/mentoring, supporting professional development, and providing appropriate and timely performance feedback to staff, both informally and during formal review processes. - As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively. - Perform other duties as assigned. What you will bring: - Bachelor's degree or four (4) years of experience (Required). - Three (3) years of experience in a management/leadership role (Required). - Three (3) years of experience in an operations environment (Required). - Familiarity with Premera products and systems. - Experience with Premera's technical training or procedures programs. - Experience with quality and production management tools and systems. - Specialized or technological knowledge/skill of auditing and systems. - Experience leading virtual employees. What you will gain: Strategic Communication & Influence Strengthening the ability to translate complex operational insights into clear, compelling messages that inspire teams, build trust across departments, and keep member needs front and center. Change Leadership & Adaptability Deepening skill in navigating organizational change—guiding teams through transitions with confidence, fostering resilience, and ensuring member experience remains strong even in shifting environments. Data‑Driven Decision Making Enhancing the use of analytics to recognize patterns, anticipate challenges, prioritize improvements, and advocate for solutions that elevate member satisfaction and operational quality. Coaching for Growth & Empowerment Advancing the ability to actively develop team members by identifying strengths, nurturing emerging talent, and creating a culture where people feel supported to take initiative and solve problems creatively. Cross‑Functional Collaboration & Relationship Building Expanding the ability to partner effectively with other business units, influence shared outcomes, and contribute to unified processes that improve consistency, efficiency, and member experience. Physical Requirements The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. - This role requires the ability to keyboard and to communicate clearly and understandably in person and over the telephone. Premera total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: - 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. Equal employment opportunity/affirmative action: Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin. The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. National Salary Range: $80,200.00 - $103,700.00 National Plus Salary Range: $80,200.00 - $118,300.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.

Role Description Premera is searching for a Business Analyst II with previous healthcare experience to help modernize how we deliver health solutions through data, AI, and automation. As a Business Analyst II, you’ll be a critical partner, working across teams to translate business needs into clear requirements and practical, optimized solutions—supporting a portfolio of AI and Automation initiatives, including efforts such as digitizing Premera’s medical policies. With some guidance, you’ll document and define requirements, contribute to process development for low to moderately complex work, and help ensure solutions create visible, measurable impact for the business and the people we serve. - Drive implementation and coordinate projects involving medical policy transformation using multiple new systems. - Manage the increasing number and proliferating complexity of medical policy formats and versions using new tools. - Be the link between appropriate clinical policy content and the technical manifestation of digital policies for use access, ensuring version integrity on all platforms. - Manage FEP policy incorporation and code management in Coding and Medical Policy System (CAMPS) and export code list reports. - Partner with Payment Integrity and external vendors to manage Routine Test Management policy versions. - Partner with IT, other departments, and external vendors to ensure successful implementation and ongoing business and system support. - Ensure business requirements are met. - Maintain system training materials. - Monitor and report on system testing. - Generate and maintain reports on transformation activities, as needed. - Investigate system problems, process flow concerns, and new enhancements. - Provide recommendations for improvement based on system knowledge. Qualifications - Bachelor’s degree or four (4) years’ work experience. (Required) - Two (2) years’ analytical experience in a technical or business environment, which includes: - One (1) year performing business analysis functions (gathering business requirements, documenting process/data flows, or performing gap analyses). (Required) - Previous AI/Automation project experience. (Preferred) - Exposure with Lean methodology or Six Sigma. (Preferred) - Extensive Project Management experience. (Preferred) - Experience with Microsoft Project, Visio, or SharePoint. (Preferred) - Experience in healthcare or other regulated industries. (Preferred) - Exposure in a project environment that uses an Agile methodology. (Preferred) - Demonstrated ability to aggregate and summarize disparate information, requirements, and/or data in a coherent manner. - Effective communication skills both verbally and in writing. - Effective interpersonal and presentation skills. - Demonstrated experience working on multiple concurrent tasks while meeting deadlines. - Experience in facilitating small group meetings and/or individual sessions to effectively meet the established objectives. - Proven ability to work both independently and as a member of a team. - Experience establishing and maintaining effective work relationships. - Demonstrated proficiency in Microsoft Word, Excel, and Outlook and process flow/modeling software. 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 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. - Generous paid time off to reenergize. - Tuition assistance for both undergraduate and graduate degrees. - Employee recognition program to celebrate anniversaries, team accomplishments, and more. - On-campus model provides flexibility with access to on-site resources, networking opportunities, and team engagement. - Commuter perks to make your trip to work less impactful on the environment and your wallet. - Free convenient on-site parking. - Subsidized on-campus cafes for affordable lunchtime connections. - Engaging on-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs. - Complementary fitness & well-being center offering in-person and virtual workouts and nutritional counseling. - Recreational activities available on campus. Equal Employment Opportunity/Affirmative Action Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. Salary Information The pay for this role will vary based on a range of factors including geographic location, market conditions, and specific skills and experience. The salary range for this role is: - National Salary Range: $80,200.00 - $103,700.00 - National Plus Salary Range: $80,200.00 - $118,300.00 We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all.