Claims Audit Manager

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 Claims Audit Manager. This role will be responsible for Gravie’s medical claim audit function, ensuring robust planning and readiness, audit execution and delivery, CAP management, reporting/socialization of results, and continual improvement of overall audit scores. The Claims Audit Manager will collaborate cross functionally across the enterprise to drive exceptional results for claims processing. Never satisfied with simply reporting the news, this role will actively seek to improve underlying processes, procedures and technology to optimize claims processing accuracy and timeliness. You will: • Maintain a claim audit process that complies with legislative, regulatory and contractual requirements and industry standards around claims quality. • Ensure consistent methodology, terminology and reporting is used during the end-to-end audit cycle. • Actively engage in root cause analysis of deficiencies, and lead efforts in the development and implementation of effective remediation, prevention and process improvement solutions. • Ensure corrective action plan (CAP) management for issues identified as part of all audits performed with clear root cause analysis and prevention plan. • Collaborate with cross functional teams (Claims, Enrollment and Eligibility, Benefits, Clinical, Pharmacy, and Product) to promote shared understanding of processes, procedures, metrics and provide timely research and remediation of issues. • Conduct special projects, including business analysis, strategic planning, and implementation efforts on new customers and changing business and organizational requirements. • Recruit, develop, motivate, and lead the Claims Audit Team to continuously improve operational performance. • Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented. You bring: • Bachelor’s Degree or equivalent work experience • At least 5 years of substantial experience in claims, including 3+ years of experience in managing a claims audit team • Expert knowledge of medical claims processing guidelines and industry standards for claims adjudication such as CMS Correct Coding standards • Proven success in improving key performance metrics, including process improvement, cost reduction, and improving efficiency • Core System configuration experience preferred • Strong independent decision-making, influencing, and analytical skills • History of managing complex processes and multi-layered projects • Excellent communication skills • Demonstrated success getting results through collaboration Extra credit: • Previous experience at a high growth company. • Certification in Medical Coding • Experience with the MPhasis Javelina claims system • Experience working with stop loss reinsurance carriers and contracts 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 $87,750 - $146,250 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. 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 businesses—making 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 transformative—and 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. Apply tot his job