Hi, we’re Gravie. Our goal is to transform how people access and pay for healthcare by offering innovative, user-friendly health benefit solutions. Our groundbreaking products and services are created and delivered by a diverse team of individuals. We value authenticity and encourage you to be yourself—we like you just the way you are.

About the Role:
As Gravie continues to prioritize a member-first approach to healthcare, the Medical Claims Examiner II will be responsible for reviewing and processing claims using our advanced claims system. This senior-level role requires deep expertise in evaluating, researching, and analyzing claims in line with national standards. Beyond handling complex claims, this person will help enhance team performance by mentoring others, assisting with training, and contributing to special projects. They will also support leadership with managing workloads, refining processes, conducting audits, and other assigned tasks.

Responsibilities:

– Participate in team discussions, help resolve claims issues efficiently, and lead by example.
– Accurately review and verify coverage to ensure claims are processed correctly, referencing Summary Plan Descriptions (SPDs), policies, and procedures.
– Promote a collaborative team environment through open and honest communication.
– Help train new team members and support ongoing development through continuous learning.
– Mentor team members to help them perform at their best by offering guidance and sharing best practices.
– Monitor claims queues and provide expert input on complex issues.
– Consistently meet department goals and quality standards set by leadership.
– Offer feedback to improve workflows and procedures.
– Clearly communicate complex claims issues through documentation and direct communication.
– Process advanced claim scenarios in accordance with SPDs, including Coordination of Benefits (COB), Prior Authorization, Claim Adjustments, Health Reimbursement Arrangements (HRA), Transplant Claims, and High-Dollar Claims.
– Provide feedback to leadership on system improvements and training needs.

Qualifications:

– High school diploma
– 4+ years of experience in medical claims processing, preferably in a TPA setting
– Strong knowledge of CPT/HCPC and ICD-10 coding standards
– Ability to prioritize tasks, manage time effectively, and work independently
– Basic proficiency with Windows and other computer applications
– Comfortable using Zoom, Microsoft Teams, or Google Meet
– General understanding of CMS claims submission regulations
– Proven ability to collaborate and achieve results
– Strong communication skills, especially when explaining complex topics

Bonus Points:

– Medical coding experience or certification
– Experience in medical billing
– Familiarity with provider data
– Background in a start-up environment
– Degree in Healthcare Administration or a related field
– Experience creating process and procedure documentation
– Familiarity with the Javelina claims processing system

About Gravie:
To revolutionize health insurance and create a plan people truly love, we need talented individuals doing impactful work. In return, we offer a rewarding employee experience with opportunities for growth, meaningful work, and a competitive compensation package.

The salary range for this role is $43,725 to $72,875 annually. Compensation is based on various factors including education, experience, and skills. This role is also eligible for Gravie’s annual bonus program and may include stock options.

Our benefits package is what sets us apart. In addition to standard health and wellness coverage, we offer alternative medicine benefits, flexible PTO, up to 16 weeks of paid parental leave, paid holidays, a 401(k) plan, cell phone reimbursement, transportation benefits, education reimbursement, and one week of paid paw-ternity leave.

More About Us:

– We’re healthcare experts. Our founders are seasoned leaders who have built successful companies in the industry.
– We’re backed by top-tier investors who share our long-term vision and have provided strong financial support.
– Our customers are loyal. We have very low revenue churn in an industry where high churn is the norm.
– Our culture is distinct. We’re non-hierarchical, merit-based, and value both strong opinions and kindness. We thrive in a fast-paced, high-performance environment and are deeply committed to making a difference in people’s lives. If you’re passionate about putting consumers first and want to work with a team that values diverse perspectives, Gravie could be the perfect fit for you. Be yourself—we like you that way.