[Remote] Director of Claims Payment & Payment Integrity Operations at Gravie

Remote

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's degree or equivalent experience
8+ years of experience in healthcare claims and payments
3+ years of team management experience
Deep understanding of applicable regulatory requirements
Strong understanding of health insurance payment integrity best practices and industry standards
Ability to make strategic decisions, plans, and actions based on data
Proven leadership and management skills
Strong analytical, problem-solving, and strategic planning skills
Excellent verbal and written communication and interpersonal skills
Demonstrated success getting results through collaboration

Responsibilities

Developing and managing claim payment and payment integrity workflows
Analyzing data to identify process improvement opportunities
Leading staff development
Managing vendor relationships
Ensuring adherence to contractual and regulatory requirements and financial control best practices
Maintaining efficient and accurate processes for claims payments and payment integrity
Implementing processes, technologies, and vendor relationships to increase the timeliness and completeness of recoupment of balances owed by providers
Ensuring claims payment, payment integrity, and balance recoupment processes meet all regulatory standards and contractual requirements
Managing relationships with third-party vendors and partners
Working closely with claims operations, optimization, clinical, and finance teams to implement innovative solutions and resolve complex issues
Implementing and maintaining robust risk management strategies to protect the organization from fraud and other risks
Leading, mentoring, and developing a team

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.

Land your dream remote job 3x faster with AI

Try Jobo Free