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Gravie logo
Gravie

We partner with brokers across the nation to improve the way people purchase and access healthcare.

Director, Claims Configuration

DirectorDirectorOtherRemoteLeadTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

141 days ago

Salary

$142.5K - $209K / year

Seniority

Lead

Bachelor Degree8 yrs expEnglish

Job Description

Director, Claims Configuration

Gravie

• Own the end-to-end claims configuration function, including benefits and plan design, pricing logic, accumulator logic, provider data, edits, networks, and adjudication rules • Establish configuration standards, including maintenance of standard codes, naming conventions, and benefit category architecture • Create and maintain a user-friendly configuration documentation library in Gravie’s knowledge management system • Maintain a well-organized configuration task management system • Implement appropriate controls and governance to ensure configuration changes are quality assured • Translate product, regulatory, and contractual requirements into scalable and repeatable configuration solutions • Serve as the subject matter expert on claims configuration capabilities and limitations • Ensure timely and accurate configuration for new products, clients, renewals, and benefit changes • Drive continuous improvement in configuration quality, turnaround time, and defect reduction • Partner with Claims Operations to minimize configuration-driven claim errors • Support root cause analysis of claims issues tied to configuration and implement corrective actions • Collaborate closely with Product, Optimization, Network, Finance, Compliance, Eligibility & Enrollment, and Technology • Create and maintain a balanced scorecard of cost, quality and time metrics with goals • Support product innovation by enabling new benefit designs and network offerings • Partner with Technology on enhancements, automation, testing frameworks, and release management related to systems used for claims processing • Lead, coach, and develop a team of claims configuration professionals • Define roles, workflows, and capacity models to support scale and growth • Support training efforts to ensure configuration knowledge is institutionalized • Ensure configurations comply with regulatory requirements, contractual obligations, and internal policies • Support audits, quality reviews, and regulatory inquiries related to claims configuration • Maintain strong documentation and change management practices to support transparency and traceability

Job Requirements

  • 8+ years of experience in claims and benefits configuration
  • 3+ years of people leadership experience, preferably in a growing or evolving organization
  • Deep knowledge of medical claims adjudication, benefit design, and claims payment logic
  • Experience working cross-functionally with Product, Network, Finance, and Technology teams
  • Strong analytical, problem-solving, and process improvement skills
  • Ability to operate both strategically and hands-on in a fast-paced, scaling environment

Benefits

  • standard health and wellness benefits
  • alternative medicine coverage
  • generous PTO
  • up to 16 weeks paid parental leave
  • paid holidays
  • a 401k program
  • transportation perks
  • education reimbursement
  • paid paw-ternity leave

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