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Full-Time

Manager of Claim Operations

Confirmed live in the last 24 hours

Gravie

Gravie

201-500 employees

Health benefits and insurance solutions provider

Fintech
Healthcare

Senior, Expert

Minneapolis, MN, USA

Hybrid position in Minneapolis, MN.

Category
Inventory Management
Quality Control & Compliance
Supply Chain Management
Operations & Logistics
Required Skills
Communications
Management
Customer Service
Data Analysis
Requirements
  • 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 or equivalent experience as a leader for an operational 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
Responsibilities
  • Prioritize Member Experience: Approach every decision with a member-first mindset, ensuring that their needs are at the forefront of your actions.
  • Enhance Claims Processing: Develop and refine end-to-end medical claims processes, including subrogation, appeals, and rapid response strategies.
  • Optimize Inventory Management: Create an advanced inventory management system that supports transparent reporting and aligns with key performance indicators (KPIs).
  • Collaborate Across Teams: Work closely with configuration, finance, stop-loss, pharmacy, and network partners to streamline operations.
  • Improve Customer Experience: Partner with customer service and account management to identify the root causes of customer issues and implement preventative measures.
  • Manage Complex Claims: Oversee complicated claims and address any escalations effectively.
  • Develop Claims Team: Coach and mentor a high-performing claims team, fostering professional growth.
  • Implement Training Programs: Establish comprehensive training for new hires and continuous development opportunities for existing staff.
  • Drive Process Improvements: Collaborate with various teams to identify and implement process enhancements, ensuring high quality and timely claim processing while meeting service level agreements (SLAs).
  • Ensure Compliance and Accuracy: Maintain audit standards to verify correct payments, proper authorizations, and resolution of any system holds.
  • Analyze Claims Data: Gather insights from data analysis to report on key metrics and propose solutions for improved practices.
  • Support New Initiatives: Provide claims support for new products and business initiatives, ensuring smooth integration.
  • Adhere to Compliance Standards: Work closely with Compliance to ensure all processes meet or exceed regulatory requirements.
  • Embody Core Values: Demonstrate our core competencies: authenticity, curiosity, creativity, empathy, and a focus on outcomes.

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Company Stage

Series E

Total Funding

$342.6M

Headquarters

Minneapolis, Minnesota

Founded

2013

Growth & Insights
Headcount

6 month growth

7%

1 year growth

27%

2 year growth

101%
Simplify Jobs

Simplify's Take

What believers are saying

  • Gravie's recent $179 million equity investment from General Atlantic and others indicates strong financial backing and growth potential.
  • The high retention rate and reported cost savings for both employers and employees suggest a highly satisfied customer base.
  • The addition of experienced executives like Ken Paulus and Andrew Reeves to the board and leadership team strengthens Gravie's strategic direction and industry expertise.

What critics are saying

  • The health insurance market is highly competitive, and Gravie must continuously innovate to maintain its edge.
  • The company's rapid growth and numerous new hires could lead to integration challenges and potential operational inefficiencies.

What makes Gravie unique

  • Gravie's Comfort plan eliminates deductibles and copays for most common healthcare services, a stark contrast to traditional health plans.
  • The inclusion of virtual musculoskeletal and mental health care services sets Gravie apart in the health benefits market.
  • Gravie Pay offers an interest-free payment solution, further reducing the financial burden on members, unlike many competitors.