Director, Claims Operations Optimization

Director, Claims Operations Optimization

Hi, 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.

A Little More About The Role

The Director, Claims Operations Optimization will lead Gravie's efforts to continuously improve and scale our claims operations. This leader will oversee a small, high-impact team that partners closely with Claims Operations, Technology, and Product leaders to develop a data-driven understanding of Gravie's claims processes and create a strategic roadmap of initiatives that enhance efficiency, timeliness, and quality.

This is a critical, cross-functional role that blends strategic vision, operational rigor, and technical understanding to enable Gravie's continued growth and operational excellence.

You Will :

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 metricsensuring 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.

You Bring :

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

Working knowledge of interoperability standards, coding methods, regulations, and insurance concepts relevant to health plan administration.

Extra credit :

Experience in a high-growth, fast-paced, and evolving environment.

Lean Six Sigma certification or equivalent process improvement expertise.

Gravie :

In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.

The salary range for this position is $133,200 - $222,000 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.

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie's package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave.

A Little More About Us :

At Gravie, we're on a mission to reinvent health benefits for small and midsize businessesmaking high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we're building the future of health benefits to reflect just that.

We're proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before.

And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformativeand we're just getting started.

At Gravie, we do things differently. We'll challenge you, and we'll welcome you challenging us. Good ideas are everyone's job here. You'll join a team that's smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve.

If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you.