Manager of Claims Operations

Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions 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 Claims Operations to lead the administration of our innovative self-funded health plans, reporting into the Director of Claims Operations. This role encompasses the entire claims experience, focusing on exceptional customer service, accuracy, quality, and efficient processing turnaround times. This Manager will partner with the Director on transformation of the claims function, owning execution within their team: modernizing workflows, building the processes that scale as we grow, and turning operational insight into lasting improvement. In addition to collaborating with other leaders within the Health Plan Operations Team, the Manager will build strong partnerships with our Pharmacy, Gravie Care, Account Management, and Network partners. You will: - Lead and Enhance Daily Claims Processing: - 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. - Optimize Inventory Management: Create an advanced inventory management system that supports transparent reporting and aligns with key performance indicators (KPIs). - Manage Complex Claims: Oversee complicated and high-dollar claims and address escalations effectively. Track issues from discovery through root cause resolution and remediation. - Analyze Claims Data: Gather insights from data analysis to report on key metrics, identify risks, and propose improvements. - 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. - Ensure Compliance and Accuracy: Maintain performance standards with our Auditing team and internal policies to verify correct payments, proper authorizations, and resolution of any system holds. Work closely with Compliance to ensure all processes meet or exceed regulatory requirements. - Develop Claims Team: - Coach and mentor a high-performing claims team consisting of both Gravie employees and vendor partners, fostering accountability, collaboration, and professional growth. - Implement Training Programs: Establish comprehensive training for new hires and continuous development opportunities for existing staff. - Collaborate Across Teams: - 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. - Prioritize Member Experience: - Approach every decision with a member-first mindset, ensuring that their needs are at the forefront of your actions. - 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 experience with Stop-Loss claim processing - Previous leadership at a TPA - Experience with Javelina as a claims processing system A LITTLE MORE ABOUT US: - We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space. - We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized. - Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average. - Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. BENEFITS Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.