Manager, Claims Optimization

Premera Blue Cross

2d•$118,900 - $202,100•Remote

About The Position

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/. The Manager, Claims Optimization is responsible for improving the performance of Claims Operations through process reengineering, workflow optimization, and data driven improvement initiatives. This position drives the adoption of AI and automation solutions at scale, ensuring measurable value through improved cycle time, accuracy, cost effectiveness, and customer experience. Positioned within Claims Operations, this role owns how claims processes are analyzed, designed, optimized, measured, and continuously improved. Using operational data and performance insights, the Manager identifies opportunities, prioritizes process enhancements, and ensures operational changes deliver sustained value once implemented. The Manager, Claims Optimization leads a team focused on continuous improvement, performance monitoring, and automation oversight. The role serves as the business owner for claims initiatives and partners closely with Product, Technology, Configuration, Analytics, and Compliance teams to ensure solutions are effective, compliant, and aligned with enterprise claims strategy.

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).

Responsibilities

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.

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.