Claims Audit Manager

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November 7

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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

• Maintain a claim audit process that complies with legislative, regulatory and contractual requirements and industry standards around claims quality. • Ensure consistent methodology, terminology and reporting is used during the end-to-end audit cycle. • Actively engage in root cause analysis of deficiencies, and lead efforts in the development and implementation of effective remediation, prevention and process improvement solutions. • Ensure corrective action plan (CAP) management for issues identified as part of all audits performed with clear root cause analysis and prevention plan. • Collaborate with cross functional teams (Claims, Enrollment and Eligibility, Benefits, Clinical, Pharmacy, and Product) to promote shared understanding of processes, procedures, metrics and provide timely research and remediation of issues. • Conduct special projects, including business analysis, strategic planning, and implementation efforts on new customers and changing business and organizational requirements. • Recruit, develop, motivate, and lead the Claims Audit Team to continuously improve operational performance. • Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.

🎯 Requirements

• Bachelor’s Degree or equivalent work experience • At least 5 years of substantial experience in claims, including 3+ years of experience in managing a claims audit team • Expert knowledge of medical claims processing guidelines and industry standards for claims adjudication such as CMS Correct Coding standards • Proven success in improving key performance metrics, including process improvement, cost reduction, and improving efficiency • Core System configuration experience preferred • Strong independent decision-making, influencing, and analytical skills • History of managing complex processes and multi-layered projects • Excellent communication skills • Demonstrated success getting results through collaboration

🏖️ Benefits

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