Premera Blue Cross · 12 hours ago
Claim Edits Coordinator
United States
Full-time
Remote
Entry, Mid Level
$80K/yr - $114K/yr
2+ years expPremera Blue Cross is committed to improving healthcare and enhancing the lives of its customers. The Claim Edits Coordinator will support the Payment Integrity Office by executing the claim payment accuracy strategy, overseeing the review and approval of new claim edit concepts, and ensuring efficient communication and alignment between teams.
Cyber SecurityHealth CareInformation TechnologyInsurance
Responsibilities
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
Qualification
Required
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
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
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, 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.
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.
Company
Premera Blue Cross
Premera is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services.
1001-5000 employees
H1B Sponsorship
Premera Blue Cross has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (21)
2024 (29)
2023 (13)
2022 (25)
2021 (15)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Jeffrey Roe
President and Chief Executive Officer
Talha Ashraf
EVP and CFO
Recent News
2025-12-04
TechTarget
2025-10-31
Company data provided by crunchbase