(TNS) — Health insurer Highmark Health has laid off 108 people in Pennsylvania. That includes 40 in central Pennsylvania, where Highmark has about 3,500 employees.

Highmark says the layoffs are part of a “transformation” which “requires that we continue the work we started in 2023 to reimagine and simplify our operations to effectively and efficiently achieve the quintuple aim — better patient experience, clinician satisfaction, health equity and health outcomes, with lower costs.”

In a written statement, Pittsburgh-based Highmark called them “difficult but necessary changes.”

“We are focused on building the workforce of the future, which requires identifying talent gaps, investing in in-demand roles, such as nursing, and adapting technologies, such as AI, to better anticipate demand and drive value for consumers,” Highmark said.

Highmark is Pennsylvania’s largest health insurer in terms of people covered. It has 42,000 employees and also has many customers in New York, West Virginia and Delaware.

It’s closely affiliated with Penn State Health, with a 20% ownership stake and a major role in funding recent expansions of Penn State Health facilities. Highmark also owns a network of hospitals in western Pennsylvania.