Manager, Claims Quality – Workforce Readiness

Job not on LinkedIn

🔥 1 minute ago

☕ Washington – Remote

☕ Washington – Remote

💵 $101.9k - $173.2k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Premera Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Premera Blue Cross is an independent health insurance provider, serving businesses and residents of Washington State and Alaska as a licensee of the Blue Cross Blue Shield Association. The company offers a range of health plans including individual, family, employer-based, and Medicare Supplement plans. However, it has announced that it will exit the Medicare Advantage market as of January 1, 2025. Premera is committed to advancing health equity and community support, evident through its Social Impact Program focused on behavioral health and homelessness solutions in Washington and Alaska. Additionally, Premera complies with federal and state civil rights laws, offering language assistance services to ensure equitable care.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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