Manager, Claims Quality – Workforce Readiness

🕒 Outubro 28

☕ Washington – Remoto

☕ Washington – Remote

💵 $101.900 - $173.200 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

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• Aberta há 14 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

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Premera Blue Cross

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1945

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Premera Blue Cross é uma provedora independente de seguro de saúde, atendendo empresas e residentes do estado de Washington e Alasca como licenciada da Blue Cross Blue Shield Association. A empresa oferece uma variedade de planos de saúde, incluindo planos individuais, familiares, baseados em empregadores e suplementares ao Medicare. No entanto, anunciou que sairá do mercado Medicare Advantage a partir de 1º de janeiro de 2025. A Premera está comprometida em promover a equidade em saúde e suporte à comunidade, evidente através de seu Programa de Impacto Social focado em saúde comportamental e soluções para a falta de moradia em Washington e Alasca. Além disso, a Premera cumpre com as leis de direitos civis federais e estaduais, oferecendo serviços de assistência linguística para garantir um cuidado equitativo.

Descrição

• Lead work across claims quality improvement, knowledge management, training, workforce readiness, and performance monitoring • Build and lead a systematic quality improvement approach across Claims Operations • Use quality findings, operational data, and customer feedback to identify trends, address root causes, and reduce recurring errors and rework • Partner with Quality Assurance and Claims production leaders on corrective actions and sustained operational improvement • Partner with Claims Optimization, IT, and other teams to leverage automation, analytics, AI, and technology solutions • Establish and govern knowledge management, documentation, training, and workforce support across Claims • Lead training specialists and partner with subject-matter experts to develop learning resources and technical support practices • Prepare employees for new systems, automation, AI-enabled workflows, and process changes • Independently monitor Claims operational performance and inventory health • Partner with Claims production leaders on corrective actions and improvement plans • Use quality, performance, and workforce insights to prioritize improvement and lead cross-functional initiatives • Build and develop a team responsible for Claims quality and workforce capabilities • Coach and develop employees through expectations, assignments, feedback, and professional development • Lead through ambiguity and change while defining the function’s structure, practices, and capabilities

🎯 Requisitos

• A bachelor's degree or four years of relevant work experience • Seven years of health plan industry or business/operational experience • Four years of experience leading and managing teams of direct reports • Health plan or healthcare operations experience, particularly within claims or another high-volume transactional environment • Experience leading complex operational functions and driving measurable improvements in quality, processes, and performance • Experience building structure and capabilities in an evolving environment • Ability to lead change, solve complex problems, and build alignment across teams • Experience using data, continuous improvement practices, technology, automation, analytics, or AI-enabled solutions to improve operational outcomes • Experience building or governing knowledge management, training, workforce readiness, or operational performance programs

🏖️ Benefícios

• Medical, vision, and dental coverage with low employee premiums • Voluntary benefit offerings, including pet insurance • Life and disability insurance • Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service • Wellness incentives, including counseling services, stress management programs, and mindfulness programs • Generous paid time off • Tuition assistance for undergraduate and graduate degrees • Employee recognition program • Flexibility for hybrid employees with access to on-site resources, networking opportunities, and team engagement • Commuter perks • Free convenient on-site parking • Subsidized on-campus cafes • On-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs • Fitness and well-being center with in-person and virtual workouts and nutritional counseling

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