Director, Claims Operations - Premera Blue Cross
Mountlake Terrace, WA
About the Job
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.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America’s 2023 Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) and America's 2023 Best Employers By State (https://www.forbes.com/lists/best-employers-by-state/?sh=21c7c3d1983b) .
Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com .
We are seeking an experienced and dynamic Claims Operations Director to join our team and oversee our claims management organization. This position offers an exceptional opportunity to contribute to a forward-thinking health insurance organization, where your expertise will play a crucial role in enhancing the quality and efficiency of our claims processes.
In this capacity, you will lead a strong claims team, drive strategic initiatives and vendor partnerships, create collaborative partnerships with our Product and Technology teams to deliver optimized operational workflows and uphold our commitment to delivering superior service to our members.
If you possess a passion for driving innovation and leadership within the healthcare sector, we invite you to advance your career with us through this compelling opportunity.
What you will do:
Lead the Organization : Provide strategic direction, business planning, and overall leadership for Premera’s healthcare payer operations across various customer segments within our organization.
+ Establish department objectives and key results aligned with the corporate strategy and objectives. Provide transparency and visibility to progress, risks, and mitigations.
+ Work collaboratively with staff throughout the enterprise to improve efficiency, enhance capabilities, and improve the performance of Premera’s operations; Engage across Premera’s Capability Product Groups, aligning roadmaps and priorities towards achieving the right business outcomes.
+ Prepare and manage the department’s operating budget, controlling expenditures within approved budgets. Provide clarity on the drivers of operational costs and implement long-range strategies for managing and reducing operations costs where practical.
+ Establish governance and utilization of Artificial Intelligence (AI) within operational processes including the requisite skill acquisition, development, and training
+ Anticipate the impact of the changing business environment and make timely pivots, both strategic and tactical, to achieve enterprise objectives utilizing strong organizational change management practices.
Oversee Organizational Operations : Work closely with both leadership and front-line staff to discover areas for process improvement and efficiency enhancements, promoting a culture of continuous improvement within the department.
+ Develop and define processes, workflows, methods, tools, training, and expected outcomes to support effective practices. Ensure expected service levels, operational goals, and organizational commitments are consistently met.
+ Drive the enhancement of technology solutions to raise operational efficiencies, increase accuracy and speed of operations, and improve employee, member, and provider experiences.
+ Ensure operations functions are fair, accurate, consistent, timely, and are delivered in a professional, caring, and customer-centric way that fosters brand loyalty.
+ Demonstrate social responsibility leadership and promote community service awareness for all employees.
+ Ensure operational compliance with member policies, provider contracts, government regulations, and other internal and external governance bodies
People Leadership : Lead an effective, high-performing team, focused on our members.
+ Provide leadership and coaching to the Operations organization, fostering a culture of accountability, professional development, learning, high performance, and ethical behavior.
+ Coach, direct, and develop and direct a high-performing team.
+ Provide oversight of technology and operations work conducted by strategic vendor partners ensuring vendors meet Premera’s business objectives, performance standards, and contractual obligations.
+ Manage and continually improve the oversight of key strategic outsourced vendors. This includes contract management and negotiation, monitoring the accuracy and timeliness of deliverables; ensuring the vendor meets Premera’s business objectives, performance standards, and contractual obligations.
What you will bring:
+ Bachelor’s degree in business or related area or four years’ work experience. (Required)
+ Eight years of experience in an operations environment, preferably in the healthcare industry. (Required)
+ Eight years of successful leadership experience, preferably in the healthcare industry. (Required)
+ Willingness to travel internationally on occasion to engage with outsourced and/or offshore vendors and staff (up to 10% of time) . (Required)
Additional preferred skills/ experiences include:
+ Master’s degree.
+ Experience in program or project management with aproven track record of implementation.
+ Experience managing outsourcedand/or offshore vendors.
+ Experience with quality and production management tools, strategies, and systems.
+ Experience in related business areas of sales, quality, and product rollout process.
+ Experience in developing, designing, and partnering with analytics and automation teams and vendors.
#LI-SS1
What we offer
+ Medical, vision and dental coverage
+ Life and disability insurance
+ Retirement programs (401K employer match and pension plan)
+ Wellness incentives, onsite services, a discount program and more
+ Tuition assistance for undergraduate and graduate degrees
+ Generous Paid Time Off to reenergize
+ Free parking
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 _._
Salary Range:
$150,000.00 - $300,000.00
At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.
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.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America’s 2023 Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) and America's 2023 Best Employers By State (https://www.forbes.com/lists/best-employers-by-state/?sh=21c7c3d1983b) .
Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com .
We are seeking an experienced and dynamic Claims Operations Director to join our team and oversee our claims management organization. This position offers an exceptional opportunity to contribute to a forward-thinking health insurance organization, where your expertise will play a crucial role in enhancing the quality and efficiency of our claims processes.
In this capacity, you will lead a strong claims team, drive strategic initiatives and vendor partnerships, create collaborative partnerships with our Product and Technology teams to deliver optimized operational workflows and uphold our commitment to delivering superior service to our members.
If you possess a passion for driving innovation and leadership within the healthcare sector, we invite you to advance your career with us through this compelling opportunity.
What you will do:
Lead the Organization : Provide strategic direction, business planning, and overall leadership for Premera’s healthcare payer operations across various customer segments within our organization.
+ Establish department objectives and key results aligned with the corporate strategy and objectives. Provide transparency and visibility to progress, risks, and mitigations.
+ Work collaboratively with staff throughout the enterprise to improve efficiency, enhance capabilities, and improve the performance of Premera’s operations; Engage across Premera’s Capability Product Groups, aligning roadmaps and priorities towards achieving the right business outcomes.
+ Prepare and manage the department’s operating budget, controlling expenditures within approved budgets. Provide clarity on the drivers of operational costs and implement long-range strategies for managing and reducing operations costs where practical.
+ Establish governance and utilization of Artificial Intelligence (AI) within operational processes including the requisite skill acquisition, development, and training
+ Anticipate the impact of the changing business environment and make timely pivots, both strategic and tactical, to achieve enterprise objectives utilizing strong organizational change management practices.
Oversee Organizational Operations : Work closely with both leadership and front-line staff to discover areas for process improvement and efficiency enhancements, promoting a culture of continuous improvement within the department.
+ Develop and define processes, workflows, methods, tools, training, and expected outcomes to support effective practices. Ensure expected service levels, operational goals, and organizational commitments are consistently met.
+ Drive the enhancement of technology solutions to raise operational efficiencies, increase accuracy and speed of operations, and improve employee, member, and provider experiences.
+ Ensure operations functions are fair, accurate, consistent, timely, and are delivered in a professional, caring, and customer-centric way that fosters brand loyalty.
+ Demonstrate social responsibility leadership and promote community service awareness for all employees.
+ Ensure operational compliance with member policies, provider contracts, government regulations, and other internal and external governance bodies
People Leadership : Lead an effective, high-performing team, focused on our members.
+ Provide leadership and coaching to the Operations organization, fostering a culture of accountability, professional development, learning, high performance, and ethical behavior.
+ Coach, direct, and develop and direct a high-performing team.
+ Provide oversight of technology and operations work conducted by strategic vendor partners ensuring vendors meet Premera’s business objectives, performance standards, and contractual obligations.
+ Manage and continually improve the oversight of key strategic outsourced vendors. This includes contract management and negotiation, monitoring the accuracy and timeliness of deliverables; ensuring the vendor meets Premera’s business objectives, performance standards, and contractual obligations.
What you will bring:
+ Bachelor’s degree in business or related area or four years’ work experience. (Required)
+ Eight years of experience in an operations environment, preferably in the healthcare industry. (Required)
+ Eight years of successful leadership experience, preferably in the healthcare industry. (Required)
+ Willingness to travel internationally on occasion to engage with outsourced and/or offshore vendors and staff (up to 10% of time) . (Required)
Additional preferred skills/ experiences include:
+ Master’s degree.
+ Experience in program or project management with aproven track record of implementation.
+ Experience managing outsourcedand/or offshore vendors.
+ Experience with quality and production management tools, strategies, and systems.
+ Experience in related business areas of sales, quality, and product rollout process.
+ Experience in developing, designing, and partnering with analytics and automation teams and vendors.
#LI-SS1
What we offer
+ Medical, vision and dental coverage
+ Life and disability insurance
+ Retirement programs (401K employer match and pension plan)
+ Wellness incentives, onsite services, a discount program and more
+ Tuition assistance for undergraduate and graduate degrees
+ Generous Paid Time Off to reenergize
+ Free parking
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 _._
Salary Range:
$150,000.00 - $300,000.00
At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.
As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.
Source : Premera Blue Cross
