Manager, Digital Claims Optimization

Premera Blue Cross•Mountlake Terrace, WA

3d•$118,900 - $230,500•Hybrid

About The Position

Help redefine how claims work gets done—at scale and with purpose. As the Manager, Digital Claims Optimization, you’ll lead the design and operational delivery of automation and AI-enabled workflow solutions that replace manual, repetitive work with reliable digital decisioning. You’ll partner across Product, Technology, and Configuration to build well-controlled process automations, performance dashboards, and data-driven improvements that shorten cycle times, strengthen accuracy, and elevate the member experience. This is a hands-on leadership role for someone who wants to build, not just manage—someone energized by solving complex operational problems through smart use of technology and motivated by advancing Premera’s values through thoughtful decisions and making healthcare work better for our members. The Manager, Digital Claims Optimization is responsible for transforming Claims Operations by translating business needs into scalable automation solutions and system enhancements. This role owns end-to-end operational delivery of automation initiatives—from process analysis and requirements definition through testing, implementation, and adoption into day-to-day workflows—and serves as the business owner for automation and enterprise changes impacting Claims Operations. Success in this role requires strong systems thinking, a data-driven mindset, and the ability to lead across teams, balancing hands-on solution development with coaching and developing a team to deliver impactful, sustainable outcomes. Note: Candidates that live within 30 miles of Mountlake Terrace, WA will be required to work hybrid.

Requirements

Bachelor’s degree in a technical or quantitative field (e.g., computer science, information systems, engineering, data analytics, or a related discipline) is preferred or 4 years of relevant experience (Required).
5 years of experience in the following areas (Required): Digitizing and automating operational workflows, or Application development in a business environment, or Data analysis and business intelligence reporting.
2 years of hands‑on experience in data analysis and reporting, including building and using dashboards and operational reports (e.g., Tableau, Power BI) (Required).
3 years of management experience, including accountability for delivery quality, team development, and leading teams through change (Required).

Nice To Haves

Experience scaling automation across multiple workflows or operational areas using repeatable delivery patterns.
Familiarity with claims operations or similar process‑driven domains.
Experience building dashboards and operational reporting using Power BI, Tableau, or equivalent BI tools.
Familiarity with SDLC practices and backlog or ticketing tools.
Practical application of continuous improvement methods within automated operations.
Demonstrated ability to operate at the intersection of business and technology, translating system or automation changes into practical, operational outcomes.

Responsibilities

Drive the digitization and automation of priority Claims Operations workflows—using process automation and AI-enabled decisioning—to improve cycle time, accuracy, and customer experience.
Design scalable, well-controlled automated workflows and decision paths that are aligned to operational needs and enterprise claims strategy.
Build and maintain dashboards and operational reporting to measure workflow performance, automation effectiveness, and post-implementation outcomes.
Use data to identify bottlenecks and continuously optimize workflows through targeted automation and process improvements.
Own end-to-end delivery for claims automation and operational change (requirements, testing/UAT coordination, defect management, readiness sign-off, and implementation).
Ensure strong governance by understanding and operating assigned internal controls and overseeing third parties (as applicable) in alignment with contracts and Premera standards.

Benefits

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 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.
Generous paid time off to reenergize.
Tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
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.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Challenge someone to a game of shuffleboard or ping pong while on campus.