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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
94 days ago
Salary
$118.9K - $202.1K / year
Seniority
Senior
Job Description
Manager, Claims Optimization
Premera Blue Cross
• 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.
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