Director of Claims Payment & Payment Integrity Operations
About Gravie
Gravie's mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions. They are looking for unique individuals to join their team and encourage you to be your authentic self.
About the Role
Gravie is seeking a Director to lead claims payment and payment integrity operations. This role involves developing and managing claim payment and payment integrity workflows, analyzing data for process improvement, leading staff development, managing vendor relationships, and ensuring adherence to contractual and regulatory requirements and financial control best practices.
Key skills for this role include:
- Strong leadership
- Strategic thinking
- Analytical expertise
- Communication skills
Responsibilities
You will:
- Maintain efficient and accurate processes for claims payments and payment integrity that meet Gravie’s obligations for payment timeliness.
- Implement processes, technologies, and potentially vendor relationships to increase the timeliness and completeness of Gravie’s recoupment of balances owed by providers.
- Ensure the claims payment, payment integrity, and balance recoupment processes meet all regulatory standards and contractual requirements.
- Manage relationships with third-party vendors and partners, ensuring performance standards and contractual obligations are consistently met.
- Work closely with claims operations, optimization, clinical, and finance teams to implement innovative solutions and resolve complex issues.
- Implement and maintain robust risk management strategies to protect the organization from fraud and other risks.
- Lead, mentor, and develop a team, fostering a culture of accountability and continuous improvement.
Requirements
You bring:
- 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 in areas such as subrogation, coordination of benefits, data mining, credit balance recoupment, and fraud/waste/abuse detection.
- Ability to make strategic decisions, plans, and actions based on data.
- Proven leadership and management skills, with experience building and motivating teams.
- Strong analytical, problem-solving, and strategic planning skills.
- Excellent verbal and written communication and interpersonal skills.
- Demonstrated success getting results through collaboration.
Gravie
Gravie offers a great employee experience with opportunities for career growth, meaningful mission-driven work, and an above-average total rewards package.
Compensation
The salary range for this position is $118,275 - $197,125 annually. Numerous factors including, but not limited to, educations, 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.
Benefits
Gravie's benefits package includes:
- Standard health and wellness benefits
- Alternative medicine coverage
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401k program
- Cell phone reimbursement
- Transportation perks
- Education reimbursement
- 1 week of paid paw-ternity leave
About Us
Gravie is on a mission to reinvent health benefits for small and midsize businesses, making high-quality, affordable healthcare accessible to employers and their employees. They offer both innovative level-funded health plans and a market-leading ICHRA solution.