Director, Claims Operations

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 and America's 2023 Best Employers By State.

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.