Manager, Claims Optimization

Workforce Classification:

Telecommuter

 

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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.

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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.

What you will do:

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.

What you will bring:

• 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).

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:

$118,900.00 - $202,100.00

National Plus Salary Range:

$135,600.00 - $230,500.00

*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.