Claims Operations Systems Analyst

Employment Type: Full Time

Position Overview

Gravie is seeking a Claims Operations Systems Analyst to join our Health Plan Administration (HPA) team. This role is crucial for managing and enhancing our claims processing system, Javelina, and its associated vendor integrations and workflows. As a subject matter expert and functional lead, you will be instrumental in designing, implementing, and testing changes to our claims technology and processes, ensuring accuracy, reliability, and efficiency in claims processing and data transmission (EDI). You will collaborate with leadership, stakeholders, and requestors to prioritize initiatives, conduct research, perform Root Cause Analysis (RCA), and coordinate testing.

Responsibilities

• Provide subject matter expertise on claims systems and processes to support users across the organization.
• Create and maintain Standard Operating Procedures (SOPs), user manuals, and desk-level procedures.
• Support strategic technology and process improvement projects, including gap analysis, requirements gathering, and user acceptance testing.
• Maintain vendor platform functionality, monitor platform KPIs, and ensure alignment with organizational SLAs/KPIs.
• Coordinate testing for the Javelina platform, ensuring thorough testing by all teams for system functions and defect resolutions.
• Build and manage vendor relationships during implementation, establishing issue management and SLA monitoring.
• Facilitate internal user groups to gather feedback on vendor platforms' usability, accessibility, and compatibility.
• Demonstrate commitment to Gravie's core values: authenticity, curiosity, creativity, empathy, and results-driven outcome orientation.

Requirements

• Bachelor’s Degree or equivalent experience.
• 5 years of experience in business analysis and/or product management within the healthcare industry.
• Expertise in end-to-end claim adjudication processes and applications.
• Experience supporting complex processes and multi-layered projects.
• Exceptional analytical, conceptual thinking, and problem-solving skills.
• Advanced technical skills, with familiarity with Javelina or similar platforms.
• Strong communication, documentation, and reporting skills, including presentation experience.
• Proven track record of delivering results through collaboration and effective project management.

Extra Credit

• Previous startup company experience.
• Direct Javelina claims system experience.
• Understanding of stop-loss and reinsurance arrangements and operations.
• Business Analyst or Product Owner certification.

About Gravie

Gravie's 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.