Claim Edits Coordinator

Workforce Classification

Telecommuter

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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.

• 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.

• 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.