Director, Claims Operations

Workforce Classification:

Hybrid

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 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 America's Dream Employers list. In 2024, Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Diversity, and America's Greatest Workplaces for Mental Wellbeing. Additionally in 2024, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

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. 

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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.

• Engaging on-site events and activities include food trucks, health and wellness, DEI and disaster preparedness fairs, coffee connects, 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 [email protected] or via phone at 425-918-4785.

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.

Salary Range:

$153,700.00 - $307,400.00

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 a diverse and inclusive environment where all employees are celebrated for their unique skills and contributions.