Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
We're seeking a Manager of Claim Operations to lead the administration of our innovative self-funded health plans. This role encompasses the entire claims experience, focusing on exceptional customer service, accuracy, quality, and efficient processing turnaround times. In addition to collaborating with other leaders within the HPA Operations Team, the Manager will build strong partnerships with our Pharmacy, Gravie Care, Account Management, and Network partners.
You will:
· 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.
You Bring:
· 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
Extra credit
· Previous startup company experience
· Previous leadership at a TPA
· Experience with Javelina as a claims processing system
Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie's package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.
