Design and deliver automation and AI-enabled workflow solutions to replace manual claims processes. Translate ambiguous business needs into functional requirements and manage the project lifecycle to improve operational efficiency.
Premera Blue Cross
8 Remote Job Openings at Premera Blue Cross
Care Coordinator - Clinical Appeals RN
Premera Blue Cross
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Full Time
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5 days ago
Premera Blue Cross
Perform clinical appeals and medical necessity reviews for inpatient and outpatient services to ensure cost-effective care. Collaborate with Medical Directors and cross-functional departments to apply clinical criteria and maintain regulatory compliance.
Perform prospective medical necessity reviews for outpatient services and procedures to ensure cost-effective care. Collaborate with Medical Directors and internal departments to ensure compliance with clinical criteria, medical policies, and regulatory standards.
Perform medical necessity reviews for inpatient and outpatient services to ensure cost-effective care and compliance with medical policies. Collaborate with Medical Directors and internal departments to document clinical information and support quality improvement initiatives.
Coordinate the implementation of new business wins and renewals by managing timelines and cross-functional execution. Provide proactive customer support to ensure a positive experience for employer groups and producers.
Assistant Medical Director- Behavioral Health Focus (.5 Part Time)
Premera Blue Cross
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Full Time
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a month ago
Premera Blue Cross
The Assistant Medical Director performs clinical reviews for behavioral health services to determine medical necessity and coverage based on contract language. They also participate in the development of medical review criteria and support the peer-to-peer discussion process with external providers.
As an AI Engineer IV, you will lead the development of AI/ML solutions for complex business problems, guiding the creation of multi-agent systems and implementing advanced retrieval techniques. You will also mentor junior engineers and ensure the deployment of reliable AI infrastructure.
Enterprise AI & Data Governance Analyst II
Premera Blue Cross
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Full Time
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8 months ago
Premera Blue Cross
The Enterprise AI & Data Governance Analyst II will support the organization through AI & Data Governance policy creation, implementation, compliance monitoring, data lifecycle management, and reporting. This role involves collaborating with cross-functional teams to ensure adherence to governance policies and procedures while proactively identifying risks and opportunities.
