Director Claims Operations
Director Claims Operations
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 153700 - 307400
1 Vacancy
Job Description
Workforce Classification:
HybridJoin Our Team: Do Meaningful Work and Improve Peoples 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 are fostering a culture that emphasizes employee growth collaborative innovation and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted retained and thrives. As a testament to these efforts Premera has been recognized on the 2025 Americas Dream Employers list. In 2024 Newsweek honored Premera as one of Americas Greatest Workplaces Americas Greatest Workplaces for Diversity and Americas Greatest Workplaces for Mental Wellbeing. Additionally in 2024 Forbes ranked Premera among Americas Best Midsize Employers for the fourth time.
Learn how Premera supports our members customers and the communities that we serve through our Healthsource blog: 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 forwardthinking 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 Premeras 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 Premeras operations; Engage across Premeras Capability Product Groups aligning roadmaps and priorities towards achieving the right business outcomes.
- Prepare and manage the departments operating budget controlling expenditures within approved budgets. Provide clarity on the drivers of operational costs and implement longrange 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 frontline 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 customercentric 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 highperforming 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 highperforming team.
- Provide oversight of technology and operations work conducted by strategic vendor partners ensuring vendors meet Premeras 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 Premeras business objectives performance standards and contractual obligations.
What you will bring:
- Bachelors 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:
- Masters 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.
#LISS1
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 theyre a reflection of our commitment to your health and wellbeing. 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 wellbeing 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 oncampus model provides flexibility to create your own routine with access to onsite resources networking opportunities and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient onsite parking.
Subsidized oncampus cafes make lunchtime connections with colleagues fun and affordable.
Engaging onsite events and activities include food trucks health and wellness DEI and disaster preparedness fairs coffee connects and more.
Our complementary fitness & wellbeing center offers both inperson 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 or via phone at.
The pay for this role will vary based on a range of factors including but not limited to a candidates 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.
Salary Range:
$153700.00 $307400.00Were happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. Were committed to creating a diverse and inclusive environment where all employees are celebrated for their unique skills and contributions.
Required Experience:
Director
Employment Type
Full-Time
