Job Description
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 The role:
We’re looking for a Vice President, Claims to join our Health Plan Operations team. This role is responsible for leading the teams who design, operate, and optimize our benefit configuration, claim adjudication, and provider payment functions. The Vice President, Claims will also develop and execute strategies to improve the cost, quality, and efficiency of Gravie’s health plans, such as integration of new provider networks and enhancement of payment integrity programs.
You will:
● Lead the teams responsible for end-to-end processing of medical and pharmacy claims from receipt through payment, including appeals and escalations.
● Ensure compliance with all contractual agreements, plan documents, and applicable regulations.
● Use data to understand all aspects of the claims operation, efficiently match supply to demand throughout the claims process, and identify synergies between workflows to eliminate unnecessary, redundant or inefficient work.
● Create and maintain process flows and standard operating procedures to ensure reliable execution.
● Provide business requirements and cross-functional support to the teams building Gravie’s technology applications.
● Support the creation of new and innovative health benefit plans, including developing innovative and efficient methods for delivery of Gravie’s promise of health benefits that everyone can love.
● Create processes for identifying process, system, and policy gaps affecting the timeliness, quality, and/or efficiency of our claims process; diagnosing root causes and other contributing factors; and architecting effective, sustainable solutions.
● Partner with the leadership of our Gravie Care member service operation to ensure escalation workflows are designed and operated effectively and our knowledge bases and training materials are timely, accurate and easy to digest.
● Possess a deep knowledge of regulations and compliance requirements related to self- and level funded health plans and other components of employer health benefits offerings, including HRAs, HSAs, FSAs, dental, vision, and wellness benefits.
● Develop and communicate performance metrics and business updates internally and across the Gravie organization.
● Develop people to be the best they can be, motivate, empower, and encourage innovation from all employees.
● Build and maintain a comprehensive model of claims operations tasks and translate this model into effective cost of service modeling and metrics to drive budgeting, cost reduction decisions and business cases for investment.
● Demonstrate commitment to our core competencies of being authentic, curious, empathetic, creative and outcome oriented.
You bring:
● 15+ years of experience in health plan operations at a TPA or carrier with a deep understanding of self and level funded plans, including experience designing and reengineering operational processes.
● Ability to lead, support and develop front-line supervisors and managers and dive in and directly contribute key initiatives.
● Deep subject matter expertise in medical claims.
● Previously demonstrated success in project planning and execution.
● Working knowledge of network and provider contracts.
● Excellent communication skills.
● Demonstrated success getting results through collaboration.
Extra credit:
● Experience with the Mphasis Javelina claims processing platform.
● Experience with level-funded and self-pay health plans.
● Experience or qualification in Lean methodology.
Gravie:
In order to create a more equitable and sustainable future for employer-sponsored health insurance, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.
The salary range for this position is $214,125 – 314,050 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation. In addition to base salary, this position is also eligible to participate in Gravie’s annual bonus program. Stock options may also be awarded as part of the compensation package.
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, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave.
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. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
