Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions 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.
A Little More About The role:
We’re looking for a Vice President, Claims to join our Health Plan Operations team. This role is responsible for leading the teams who design, operate, and optimize our benefit configuration, claim adjudication, and provider payment functions. The Vice President, Claims will also develop and execute strategies to improve the cost, quality, and efficiency of Gravie’s health plans, such as integration of new provider networks and enhancement of payment integrity programs.
You will:
● Lead the teams responsible for end-to-end processing of medical and pharmacy claims from receipt through payment, including appeals and escalations.
● Ensure compliance with all contractual agreements, plan documents, and applicable regulations.
● Use data to understand all aspects of the claims operation, efficiently match supply to demand throughout the claims process, and identify synergies between workflows to eliminate unnecessary, redundant or inefficient work.
● Create and maintain process flows and standard operating procedures to ensure reliable execution.
● Provide business requirements and cross-functional support to the teams building Gravie’s technology applications.
● Support the creation of new and innovative health benefit plans, including developing innovative and efficient methods for delivery of Gravie’s promise of health benefits that everyone can love.
● Create processes for identifying process, system, and policy gaps affecting the timeliness, quality, and/or efficiency of our claims process; diagnosing root causes and other contributing factors; and architecting effective, sustainable solutions.
● Partner with the leadership of our Gravie Care member service operation to ensure escalation workflows are designed and operated effectively and our knowledge bases and training materials are timely, accurate and easy to digest.
● Possess a deep knowledge of regulations and compliance requirements related to self- and level funded health plans and other components of employer health benefits offerings, including HRAs, HSAs, FSAs, dental, vision, and wellness benefits.
● Develop and communicate performance metrics and business updates internally and across the Gravie organization.
● Develop people to be the best they can be, motivate, empower, and encourage innovation from all employees.
● Build and maintain a comprehensive model of claims operations tasks and translate this model into effective cost of service modeling and metrics to drive budgeting, cost reduction decisions and business cases for investment.
● Demonstrate commitment to our core com