Medical Claims Manager

JOB DESCRIPTIONHi, we're Gravie. Our 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.
We're looking for a Medical Claims Manager to oversee the administration of our own innovative self-funded health plans. The Claims Manager is responsible for the entire claims experience including providing amazing customer service, accuracy, quality, and efficient claims processing turnaround time. This person will also develop strong partnerships with our pharmacy and network partners.
You will:·       Imagine you're walking in our members shoes each time you make a decision or contemplate a course of action.·       Play a key role in transitioning claims administration back to Gravie from an outsourced vendor.·       Establish processes and procedures to support the end-to-end medical claims and HRA processing flow.·       Works daily with the configuration, finance, stop loss and appeals and grievances teams.·       Work with our pharmacy and network partners to ensure all Gravie members receive a smooth claims processing experience.·       Work closely with our customer service and account management teams to identify why customer issues and concerns may be occurring, and work to identify how we can prevent them from happening in the first place.·       Manage complex claims situations and any escalations that occur.·       Develop and coach an amazing claims team.·       Establish a claims training program for new hires and ongoing professional growth opportunities for the team.·       Partner with other teams to identify process improvements, deliver high quality and low processing turnaround time, and ensure SLA's are met or exceeded.·       Establish audit parameters to ensure claims are approved or denied for payment by marking certain the payment is correct, verifying the proper authorizations were submitted, and resolving any system hold codes.·       Analyze data to gather insights and report on key metrics related to claims.·       Propose solutions to support effective practices and communicate potential areas of risk.·       Provide claims support for new products or other business initiatives.·       Work closely with Compliance to ensure all practices meet or exceed regulatory requirements.·       Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented. You bring:·       Bachelor's Degree or equivalent experience·       Subject matter expertise of medical claims knowledge and understanding end to end processes·       At least 5 years of substantial experience in claims, including previous experience managing a team·       Strong understanding of self- and level-funded health plans·       Strong problem-solving skills·       Commitment to providing amazing member experiences and touchpoints·       Excellent communication skills·       Demonstrated success getting results through collaboration Extra credit·       Previous startup company experience·       Previous leadership at a TPA Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie's package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.