Technical Analyst - Claims Automation

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. A LITTLE MORE ABOUT THIS ROLE We’re looking for a Technical Analyst focused on Claims Automation to join our configuration team. In this role, you will drive auto-adjudication and workflow optimization by identifying manual claim scenarios and designing systemic solutions. You will partner closely with engineering, vendors, and internal teams to expand automated capabilities, increase efficiency, and lower cost per claim. YOU WILL - Identify high-volume manual claim scenarios and evaluate opportunities for automation - Design and implement automation enhancements within the claims processing system - Partner with engineering and vendors, including Mphasis, to expand systemic and auto-adjudication capabilities - Analyze claims workflows and system logic to identify inefficiencies and recommend improvements - Translate business requirements into technical solutions aligned with claims processing standards - Document automation workflows, business rules, and system configurations - Monitor auto-adjudication performance metrics and identify opportunities to improve turnaround time and accuracy - Support testing and validation of system changes and automation enhancements - Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic, and outcome oriented - Support EDI workflows and troubleshoot transaction issues including 837 claim submissions and 835 remittance files in partnership with the EDI team YOU BRING - 3+ years of experience in claims systems, business analysis, or healthcare IT - Understanding of claims adjudication processes and system workflow logic - Working knowledge of SQL or similar tools for analyzing data and system performance - Experience identifying and implementing process automation or system enhancements - Ability to translate complex business problems into technical requirements - Strong analytical and problem-solving skills with attention to detail - Experience working cross-functionally with engineering, operations, and vendor partners EXTRA CREDIT - Familiarity with Javelina or similar claims processing platforms - Working knowledge of EDI formats (837/835) and medical coding systems - Experience with vendor management and SLA monitoring - Previous startup or high-growth company experience 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. JOB APPLICANTS If you apply for employment with Gravie, personal information collected via our applicant tracking vendor is subject to our standalone California Job Applicant Notice at Collection, accessible directly within the application workflow and separate from this Policy.