Claims Quality Auditor

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🕒 May 6

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Gravie

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

Healthcare Insurance • Fintech • B2B

Gravie is a company specializing in providing innovative health benefits and insurance solutions. Their offerings include the Comfort health plan, which simplifies health coverage with no deductibles and zero copays on common healthcare services. Gravie also provides Individual Coverage Health Reimbursement Arrangements (ICHRA) and Gravie Pay, a support system for managing healthcare costs. The company emphasizes clear and straightforward benefits that facilitate preventive care and reduce unexpected healthcare expenses, catering to both individual members and small to midsize businesses. Gravie aims to make health benefits accessible, understandable, and cost-effective for employers and employees alike.

📋 Description

• Ensure the accurate and correct processing of medical claims based on contractual obligations and regulatory requirements • Conduct pre-payment, post-payment, and auto-adjudication audits for claims • Ensure processing, payment, and financial accuracy of claims • Meticulously track and report audit results • Identify corrections and confirm accuracy of adjustments • Escalate trends and issues for process improvement • Investigate claim issues to improve standard processing guidelines • Participate in cross-functional quality committees • Support testing efforts for claims system upgrades • Participate in client external audits • Process claims and create policies as necessary

🎯 Requirements

• Bachelor’s Degree or equivalent work experience • 2 years of experience auditing medical claims for a health insurer or TPA • Extensive (5 years) medical claims processing background • Ability to analyze data and recognize trends; use of the 5 Whys to determine the true root cause of an issue • Core system configuration knowledge • Ability to articulate findings and defend methodology used to produce findings • Strong independent decision-making, influencing, and analytical skills • Excellent communication skills • Demonstrated success getting results through collaboration • Previous startup company experience (extra credit) • Previous Payment Integrity experience (extra credit) • Coding certification from AAPC or AHIMA (extra credit) • Familiarity with Javelina claims processing software (extra credit)

🏖️ Benefits

• Alternative medicine coverage • Generous PTO • Up to 16 weeks paid parental leave • Paid holidays • 401k program • Transportation perks • Education reimbursement • Paid paw-ternity leave