Gravie is hiring a
Manager of Claim Operations

Summary

Join Gravie as Manager of Claim Operations to lead the administration of innovative self-funded health plans, focusing on exceptional customer service, accuracy, quality, and efficient processing turnaround times.

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

Responsibilities

• Prioritize Member Experience: Approach every decision with a member-first mindset, ensuring that their needs are at the forefront of your actions
• Enhance Claims Processing: Develop and refine end-to-end medical claims processes, including subrogation, appeals, and rapid response strategies
• Optimize Inventory Management: Create an advanced inventory management system that supports transparent reporting and aligns with key performance indicators (KPIs)
• Collaborate Across Teams: Work closely with configuration, finance, stop-loss, pharmacy, and network partners to streamline operations
• Improve Customer Experience: Partner with customer service and account management to identify the root causes of customer issues and implement preventative measures
• Manage Complex Claims: Oversee complicated claims and address any escalations effectively
• Develop Claims Team: Coach and mentor a high-performing claims team, fostering professional growth
• Implement Training Programs: Establish comprehensive training for new hires and continuous development opportunities for existing staff
• Drive Process Improvements: Collaborate with various teams to identify and implement process enhancements, ensuring high quality and timely claim processing while meeting service level agreements (SLAs)
• Ensure Compliance and Accuracy: Maintain audit standards to verify correct payments, proper authorizations, and resolution of any system holds
• Analyze Claims Data: Gather insights from data analysis to report on key metrics and propose solutions for improved practices
• Support New Initiatives: Provide claims support for new products and business initiatives, ensuring smooth integration
• Adhere to Compliance Standards: Work closely with Compliance to ensure all processes meet or exceed regulatory requirements
• Embody Core Values: Demonstrate our core competencies: authenticity, curiosity, creativity, empathy, and a focus on outcomes

Benefits

• Competitive pay is standard
• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks paid parental leave
• Paid holidays
• Cell phone reimbursement
• Education reimbursement
• 1 week of paid paw-ternity leave