[Remote] Director, Claims Operations Optimization at Gravie

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

8+ years of progressive experience in process improvement, operations leadership, operations engineering, consulting, and/or quality improvement
3+ years in a senior leadership or people management role
Strong understanding of claims processing, payment integrity, and operational best practices relevant to level-funded commercial health plans
Experience designing and delivering large-scale initiatives with measurable outcomes
Expertise in data analysis, process mapping, and operational design
Experience leveraging enabling technologies such as automation, analytics, and

Responsibilities

Partner with senior leadership to define and execute the strategy for Gravie’s claims operations infrastructure, including technology, vendors, and process design
Develop a clear roadmap of investments and initiatives that advance operational performance and align with organizational goals
Build and manage a small team of high-performing Operations Optimization Product Managers
Foster a culture of continuous improvement, accountability, and innovation within the team
Lead a systematic, data-driven review process to update and refine the operations optimization roadmap
Define, track, and report on a balanced scorecard of claims performance metrics—ensuring alignment with regulatory, contractual, and financial targets
Oversee the creation and maintenance of comprehensive business requirements for systems and tools supporting claims processing, data exchange, stop-loss operations, payments, and plan document generation
Partner with Technical Product Management and Engineering leadership to prioritize initiatives and define clear requirements and acceptance criteria
Ensure strong, consistent communication with stakeholders across Gravie to share updates, gather feedback, and drive adoption of new capabilities and processes
Maintain an expert understanding of compliance requirements, contractual obligations, regulatory changes, and industry standards
Drive build-vs-buy decisions that balance innovation with efficiency, optimizing Gravie’s internal focus on distinctive capabilities
Be accountable for the execution and measurable success of the operations optimization roadmap, including operational and financial performance improvements tied to specific initiatives

Skills

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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