Teams at Premera Blue Cross

Conducts retrospective and prospective audits of healthcare claims, coding, billing, documentation, and reimbursement to identify fraud, waste, abuse, and irregularities. Analyzes trends, investigates complex cases, determines overpayments, documents findings, supports legal proceedings, and recommends corrective actions. The role also develops fraud prevention strategies, collaborates with stakeholders, mentors junior auditors, and leads audit process improvements while maintaining regulatory compliance and confidentiality.

Transforms complex workforce and operational data into actionable insights through reports, dashboards, data models, forecasting, and performance analytics. Partners with stakeholders to define requirements, improve data quality, resolve reporting issues, support compliance, and guide business decisions. Leads complex analytical initiatives, establishes reporting standards, mentors analysts, documents processes, and develops scalable automated solutions for workforce planning, capacity, scheduling, and operational performance.

Serves as a strategic liaison for Premera’s Inter-Plan business, developing renewal and growth strategies, negotiating contracts, coordinating compliance, and overseeing multi-state healthcare operations. Partners with internal teams, Blue Cross Blue Shield plans, brokers, employer groups, and external stakeholders to retain business, ensure regulatory and contractual compliance, improve service delivery, and support operational effectiveness. Represents Premera in industry committees and communicates regulatory and business impacts to leadership.