Claims Operations Manager

🔥 48 minutes ago

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Gravie

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

🛡️ Insurance

🤝 B2B

💰 $150M Private Equity Round - Gravie on 2025-05

Healthcare • Insurance • B2B

Gravie is a benefits and health insurance solutions company that helps small and midsize employers, brokers, and employees access and administer more flexible, affordable health benefits. Its flagship offerings include Comfort (a level-funded health plan), Gravie ICHRA (Individual Coverage Health Reimbursement Arrangement administration), Gravie Pay (support for healthcare costs), and Gravie Care; the company focuses on enabling SMBs to offer individualized, lower-cost coverage and simplifying benefits administration.

📋 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.

🎯 Requirements

• 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

🏖️ Benefits

• 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