Claims Operations Manager

🕒 il y a 10 jours

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Gravie

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2013

🏥 Santé

🛡️ Assurance

🤝 B2B

💰 €150 000 000 Private Equity Round - Gravie en 2025-05

Healthcare • Insurance • B2B

Gravie est une entreprise spécialisée dans les solutions d'assurance santé et de prestations qui aide les petites et moyennes entreprises, les courtiers et les employés à accéder et à gérer des prestations de santé plus flexibles et abordables. Ses offres phares incluent Comfort (un plan de santé à financement partiel), Gravie ICHRA (gestion des remboursements des frais médicaux pour les couvertures individuelles), Gravie Pay (assistance pour les coûts liés aux soins de santé) et Gravie Care. L'entreprise se concentre sur la capacité des PME à offrir des couvertures individualisées à moindre coût, tout en simplifiant la gestion des prestations.

Description

• Ensure all claims are processed in a timely, accurate manner. Develop and refine end-to-end medical claims processes, including adjudication, pend workflows, and payment. • Create an advanced inventory management system that supports transparent reporting and aligns with key performance indicators (KPIs). • Oversee complicated and high-dollar claims and address escalations effectively. Track issues from discovery through root cause resolution and remediation. • Gather insights from data analysis to report on key metrics, identify risks, and propose improvements. • Collaborate with various teams to identify and implement process enhancements, ensuring high quality and timely claim processing while meeting service level agreements. • Maintain performance standards with our Auditing team and internal policies to verify correct payments, proper authorizations, and resolution of any system holds. • Coach and mentor a high-performing claims team consisting of both Gravie employees and vendor partners, fostering accountability, collaboration, and professional growth. • Establish comprehensive training for new hires and continuous development opportunities for existing staff. • Work closely with configuration, optimization, finance, pharmacy, and network partners to streamline operations. Provide claims support for new products and business initiatives, ensuring smooth integration. • Approach every decision with a member-first mindset, ensuring that their needs are at the forefront of your actions. • Demonstrate our core competencies: authenticity, curiosity, creativity, empathy, and a focus on outcomes.

🎯 Exigences

• Bachelor's Degree or equivalent experience • Subject matter expertise of medical claims knowledge and understanding end-to-end processes • At least 5 years of substantial experience in claims, including previous experience managing a team or equivalent experience as a leader for an operational team • Strong understanding of self- and level-funded health plans • Strong problem-solving skills • Commitment to providing amazing member experiences and touchpoints • Excellent communication skills • Demonstrated success getting results through collaboration

🏖️ Avantages

• alternative medicine coverage • flexible PTO • up to 16 weeks paid parental leave • paid holidays • 401k program • transportation perks • education reimbursement • 2 days of paid paw-ternity leave