Director, Claims Operations

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $134k - $179k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

👻 Ghost score 0%

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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

• Lead Gravie's end-to-end claims operations across production processing, stop loss, support and appeals, and claims payments • Own claims processing lifecycle accountability for throughput, quality, timeliness, auto-adjudication targets, and first-pass resolution • Assess claims-processing error trends, identify root causes, and execute sustained quality improvements • Own stop loss claims production, including adjudication, inventory management, quality oversight, and team performance • Manage Claims Managers and a payments team through coaching, feedback, and career development • Ensure accurate and timely claims payments meeting contractual, regulatory, prompt-payment, and network-partner requirements • Champion claims automation and process improvement with Optimization, Product, Engineering, and Configuration teams • Manage claims inventory, forecast volume and staffing needs, conduct reviews, and prevent backlog accumulation • Serve as primary claims operations contact for Finance, Sales, Account Management, and Clinical teams • Manage payment, recoupment, and claims-processing vendor relationships and performance • Maintain compliance, financial controls, transparency, accuracy, and protection against fraud, credit balance risk, and other operational risks

🎯 Requirements

• Bachelor's degree or commensurate experience • 8+ years of experience in healthcare claims operations, including production processing, stop loss, support and appeals, and claims payments • 3+ years of experience leading managers and teams • Strong working knowledge of claims adjudication logic, stop loss mechanics, coordination of benefits, subrogation, recoupment, and payment integrity fundamentals • Experience identifying and driving automation and process improvement in manual-heavy environments • Familiarity with claims platforms and EDI workflows • Ability to establish decision rights, operating norms, escalation paths, cross-team communication protocols, and inventory management practices • Ability to work with operational metrics, identify trends, and build quantitative cases for process or structural changes • Current authorization to work in the United States

🏖️ Benefits

• Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • 401(k) program • Transportation perks • Education reimbursement • 2 days of paid paw-ternity leave • Equity • Bonus