Claim Edits Coordinator

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:  https://healthsource.premera.com/.

About the role of Claims Edits Coordinator

As a Claim Edits Coordinator, you will leverage your exceptional organizational and analytical abilities to support the overarching goals of the Payment Integrity Office by executing Premera’s enterprise-wide claim payment accuracy strategy. This role oversees the end-to-end process for reviewing and approving new claim edit concepts, ensuring edits are evaluated, documented, and advanced efficiently. Key responsibilities include developing review schedules, coordinating communications with vendors, assigning work to the review panel, collecting and synthesizing feedback, and facilitating alignment between pre-payment and post-payment teams. Once edits are approved, you will ensure a seamless handoff to the Claim Edits Specialists for implementation. Success in this role requires strong claim payment accuracy expertise, a solid clinical coding foundation, excellent documentation skills, a pro-active approach and outstanding communication skills.

What you’ll do:

• Serve as a subject matter expert for claim payment accuracy including pre-payment claim editing, pre-payment claim auditing, contract compliance, post-payment payment integrity solutions, etc.
• Coordinate with vendors, internal teams, and other health plans to maintain payment integrity solutions that increase claim payment accuracy.
• Serve as the liaison and primary point of contact for Blue-to-Blue invoicing and vendor invoicing, ensuring accurate and timely payment of invoices.
• Collect, analyze, track, and ensure the integrity and timely payment of incoming and outgoing payment integrity invoices.
• Proficiency with claim payment accuracy, claims processing, payment integrity tools, and claim payment issue resolution.
• Effectively respond to payment integrity and invoicing inquiries from providers, internal teams, appeals, vendors, and other health plans.
• Participate in technology/tool updates, testing, and troubleshooting with internal teams and external vendors.
• Manage scope of multiple inquiries, projects, or audits under minimal direct supervision.

What you’ll bring:

Required Qualifications

• Bachelor’s Degree or (4) years of work experience.
• (2) years of analytical experience in a technical or business-related discipline, including (1) year of experience participating in medium to large size payment integrity projects.
• Comprehensive knowledge of CPT, ICD10, HCPCS or other coding structures.

Knowledge, Skills, and Abilities

• Proven experience building and maintaining positive work relationships with internal staff, external vendors, legal teams, and state and federal agencies.
• Ability to interact effectively across department lines and with all levels of management.
• Exceptional analytical skills - demonstrated ability to ensure reliability and relevance of data collected.
• Excellent written communication skills - demonstrated ability to compose sensitive, non-routine correspondence requiring tact and diplomacy.
• Excellent speaking and presentation skills - demonstrated ability to deliver presentations regarding controversial issues, ability to deliver talks and/or speeches before groups and audiences.
• Exceptional problem-solving skills - demonstrated ability to solve a wide range of highly complex, multi-disciplinary problems, which must consider long-term company-wide planning.

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 [email protected] 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.