Director of Claims Payment & Payment Integrity Operations

Director Of Claims Payment & Payment Integrity Operations

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 :

We're looking for a Director to lead Gravie's claims payment and payment integrity operations. The Director's responsibilities include developing and managing claim payment and payment integrity workflows, analyzing data to identify process improvement opportunities, leading staff development, managing vendor relationships, and ensuring adherence to contractual and regulatory requirements and financial control best practices. Key skills for this role are strong leadership, strategic thinking, analytical expertise, and communication skills to navigate complex operational and financial challenges.

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.

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 :

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 $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.

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.