Claims Processor II

Workforce Classification:

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: .

The Claims Processor II is responsible for the accurate and timely review, research, and resolution of moderately complex claims in accordance with contracts and policies. This may include subrogation, Medicare, and coordination of benefits for dental, medical and hospital claims. Incumbent is responsible for interpreting procedures and policies to ensure accurate claims resolution. Incumbent may also be responsible for processing simple and routine claims.

What you will do:

• Review, process, and resolve moderately complex claims in accordance with contracts and policies.
• Research claims through the utilization of reference materials and on-line tools.
• Responsible for accurately coding claims through the system.
• Translate data into information acceptable to the claims processing system including follow up on pending claims.
• Maintain all appropriate claims files and perform follow-up on pending claims.
• Prepare claims for return to Provider or Subscriber when additional information is needed.
• Demonstrate adjudication proficiency to meet or exceed accuracy goals.
• Consistently meet cycle time/productivity goals that are aligned with corporate objectives.
• Maintain confidentiality of all documents/files.
• Contact other carriers or provider offices as necessary.
• May provide `buddy training' and feedback to new associates.
• May complete adjustments, reversals, and/or refunds.
• Apply commitment to quality by doing things right the first time to avoid defects from reaching customers or requiring internal re-work.

What you will bring:

• High School diploma or GED. (Required
• Six (6) months claims processing experience or customer service experience. (Required)
• Experience with out-of-area program. (Preferred)
• Technical experience of contract benefits, claims processing steps, and correction procedures. (Preferred)

What you will gain:

• Stronger claims processing and research skills.
• Knowledge of contracts, benefits, and claim procedures.
• Experience resolving moderately complex claims.
• Greater accuracy, productivity, and quality expertise.
• Opportunities to support and train new associates.

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 or via phone at 425-918-4785.

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.

Originally posted on Himalayas