Claims Processor III

Workforce Classification: Telecommuter

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.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: .

Bring your claims expertise to a role where accuracy, problem-solving, and collaboration make a meaningful difference for our members. We are hiring Claims Processor IIIs across several Claims departments, offering opportunities to apply your strengths in a team aligned with different types of claims work. You’ll research and resolve complex issues, support quality outcomes, and serve as a trusted technical resource while continuing to expand your knowledge across the Claims organization. If you are detail-oriented, motivated by getting it right the first time, and ready to grow your impact, we invite you to join us.

The Claims Processor III is responsible for the accurate and timely review, research and resolution of moderate to complex claims in accordance with contracts and policies. This may include Medicare, Department of Social & Health Services (DSHS), subrogation, or coordination of benefits for dental, medical and hospital claims, as well as large dollar medical and reprocessing of claims. Incumbent is responsible for interpreting procedures and policies to ensure accurate claims resolution.

What you will do:

• Review, research, and resolve claims in accordance with contracts and policies through the utilization of reference materials and on-line tools.
• Identify, research, and resolve coordination of benefits, subrogation and general inquiry issues and communicate the results.
• May complete claim adjustments, reversals and/or refunds.
• Act as the team technical subject matter expert including training and auditing trainee claims and providing appropriate feedback and technical support.
• Keep reference materials updated.
• Develop and maintain excellent relationships with both internal and external customers through the use of both written and verbal communications. This will include making outbound calls as well as receiving inbound calls.
• Prepare formal history reviews.
• Consistently meet cycle time/productivity goals that are aligned with corporate objectives.
• Maintain confidentiality of all documents/files.
• Other duties or special projects as assigned.
• Translate data into information acceptable to the claims processing system including follow up on pended claims.
• Apply commitment to quality by doing things right the first time in order to avoid defects from reaching customers or requiring internal re-work.

What you will bring:

• High School diploma or GED (Required).
• One (1) year claims processing or customer service experience (Required).
• Understanding of Out-of-area programs.
• In-team focused audit experience.

What you will gain:

Analytical problem-solving

Strengthen your ability to investigate complex situations, identify root causes, and determine well-reasoned solutions.

Healthcare industry expertise

Build a deeper understanding of how benefits, provider services, and member needs connect across the healthcare system.

Sound decision-making

Grow your confidence in evaluating detailed information, balancing multiple considerations, and making accurate decisions.

Technical leadership

Develop the ability to share knowledge, coach others, and become a trusted resource within a team.

Cross-functional communication

Learn to explain complex information clearly and collaborate effectively with partners across different areas of the organization.

Physical Requirements:
The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation:
This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.

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.

• 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.

• 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 View email address on aiapply.co or via phone at View phone number on aiapply.co.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .

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.

National Salary Range:

National Plus Salary Range:

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska .

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 an environment where all employees are celebrated for their unique skills and contributions.