Director, Claims Operations Optimization

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October 24

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Gravie

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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.

51 - 200 employees

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

📋 Description

• Partner with senior leadership to define and execute the strategy for Gravie’s claims operations infrastructure, including technology, vendors, and process design. • Develop a clear roadmap of investments and initiatives that advance operational performance and align with organizational goals. • Build and manage a small team of high-performing Operations Optimization Product Managers. • Foster a culture of continuous improvement, accountability, and innovation within the team. • Lead a systematic, data-driven review process to update and refine the operations optimization roadmap. • Define, track, and report on a balanced scorecard of claims performance metrics ensuring alignment with regulatory, contractual, and financial targets. • Oversee the creation and maintenance of comprehensive business requirements for systems and tools supporting claims processing, data exchange, stop-loss operations, payments, and plan document generation. • Partner with Technical Product Management and Engineering leadership to prioritize initiatives and define clear requirements and acceptance criteria. • Ensure strong, consistent communication with stakeholders across Gravie to share updates, gather feedback, and drive adoption of new capabilities and processes. • Maintain an expert understanding of compliance requirements, contractual obligations, regulatory changes, and industry standards. • Drive build-vs-buy decisions that balance innovation with efficiency, optimizing Gravie’s internal focus on distinctive capabilities. • Be accountable for the execution and measurable success of the operations optimization roadmap, including operational and financial performance improvements tied to specific initiatives.

🎯 Requirements

• 8+ years of progressive experience in process improvement, operations leadership, operations engineering, consulting, and/or quality improvement. • 3+ years in a senior leadership or people management role. • Strong understanding of claims processing, payment integrity, and operational best practices relevant to level-funded commercial health plans. • Experience designing and delivering large-scale initiatives with measurable outcomes • Expertise in data analysis, process mapping, and operational design. • Experience leveraging enabling technologies such as automation, analytics. • Working knowledge of interoperability standards, coding methods, regulations, and insurance concepts relevant to health plan administration.

🏖️ Benefits

• Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • 401k program • Cell phone reimbursement • Transportation perks • Education reimbursement • 1 week of paid paw-ternity leave