Individual Market CIR Claims Processor III

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/.

Join our team as an IM CIR Claims Processor III and play a key role in ensuring claims are reviewed, researched, and resolved with accuracy, care, and confidence. In this role, you’ll apply your claims expertise to support complex problem-solving, strengthen the customers’ experience, and serve as a trusted resource for teammates through technical guidance, quality-focused work, and collaboration across internal and external partners.

The IM CIR 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 of claims processing experience or customer service experience (Required).
• Understanding of Out-of-area programs.
• In-team focused audit experience.

What you will gain:

Complex Claims Analysis – Strengthen the ability to research, interpret, and resolve moderate to complex claims using contracts, policies, reference materials, and online tools.

Policy and Procedure Interpretation – Continue to build confidence in applying claims processing standards, regulatory requirements, benefit rules, and internal guidelines to ensure accurate outcomes.

Technical Subject Matter Expertise – Develop a deeper expertise as a go-to resource for the team by providing technical support, training, auditing trainee claims, and offering quality-focused feedback.

Customer and Partner Communication – Enhance written and verbal communication skills through interactions with internal teams, external customers, and outbound/inbound calls related to claim resolution.

Quality, Accuracy, and Process Improvement – Build stronger attention to detail, first-time accuracy, and process discipline to reduce rework, prevent defects, and support productivity and cycle-time goals.

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 careers@premera.com 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.