[Remote] Claims Audit Manager at Gravie

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Bachelor’s Degree or equivalent work experience
At least 5 years of substantial experience in claims, including 3+ years of experience in managing a claims audit team
Expert knowledge of medical claims processing guidelines and industry standards for claims adjudication such as CMS Correct Coding standards
Proven success in improving key performance metrics, including process improvement, cost reduction, and improving efficiency
Core System configuration experience preferred
Strong independent decision-making, influencing, and analytical skills
History of managing complex processes and multi-layered projects
Excellent communication skills
Demonstrated success getting results through collaboration
Previous experience at a high growth company (extra credit)
Certification in Medical Coding (extra credit)
Experience with the MPhasis Javelina claims system (extra credit)
Experience working with stop loss reinsurance (extra credit)

Responsibilities

Maintain a claim audit process that complies with legislative, regulatory and contractual requirements and industry standards around claims quality
Ensure consistent methodology, terminology and reporting is used during the end-to-end audit cycle
Actively engage in root cause analysis of deficiencies, and lead efforts in the development and implementation of effective remediation, prevention and process improvement solutions
Ensure corrective action plan (CAP) management for issues identified as part of all audits performed with clear root cause analysis and prevention plan
Collaborate with cross functional teams (Claims, Enrollment and Eligibility, Benefits, Clinical, Pharmacy, and Product) to promote shared understanding of processes, procedures, metrics and provide timely research and remediation of issues
Conduct special projects, including business analysis, strategic planning, and implementation efforts on new customers and changing business and organizational requirements
Recruit, develop, motivate, and lead the Claims Audit Team to continuously improve operational performance
Demonstrate commitment to core competencies of being authentic, curious, creative, empathetic and outcome oriented

Skills

Key technologies and capabilities for this role

Claims AuditingRoot Cause AnalysisCorrective Action PlansRegulatory ComplianceProcess ImprovementAudit ReportingClaims ProcessingCross-Functional Collaboration

Gravie

Health benefits and insurance solutions provider

About Gravie

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Minneapolis, MinnesotaHeadquarters

2013Year Founded

$333.3MTotal Funding

DEBTCompany Stage

Fintech, HealthcareIndustries

201-500Employees

Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Holidays

Paid Vacation

Paid Sick Leave

Flexible Work Hours

Paid Parental Leave

Wellness Program

Alternative Medicine Coverage

Cell Phone Reimbursement

Transportation Perks

Education Reimbursement

Paid Paw-ternity Leave

Risks

Potential backlash from traditional insurers could increase competition or lobbying.

Rapid ICHRA adoption may invite regulatory scrutiny or changes.

Aggressive expansion strategy could strain resources and lead to inefficiencies.

Differentiation

Gravie's Comfort plan offers zero deductibles and copays, unlike traditional health plans.

Gravie Pay provides interest-free payment solutions, reducing financial burdens for members.

Focus on virtual healthcare services enhances accessibility and member satisfaction.

Upsides

Increased ICHRA adoption since 2020 expands Gravie's market opportunities.

Comfort plan's zero-deductible model attracts cost-conscious employers and employees.

Virtual healthcare services align with rising demand, boosting member engagement.

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