Director, Claims Configuration
Gravie
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $142,500 - $209,000 per year
Job Level
About the role
- 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
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims configurationbenefit designpricing logicadjudication rulesconfiguration documentationroot cause analysisprocess improvementquality assuranceautomationtesting frameworks
Soft Skills
leadershipanalytical skillsproblem-solvingcollaborationcoachingtrainingorganizational skillscommunicationstrategic thinkinghands-on approach