Lead Medical Claims Examiner

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.

As Gravie looks to continue its Member-centric approach to healthcare, the Lead Medical Claims Examiner will support, review, and adjudicate claims in our best in class claim system. The Lead Examiner will be a subject matter expert, capable of thoroughly evaluating, researching, and analyzing claim submission, with a solid knowledge of national claims guidelines. In addition to personally reviewing complex claims, the Lead Examiner will play a key role in elevating the performance of the team, assisting in training, serving as a resource to other Examiners and pitching in as needed with special projects. 

You will:

· Lead team discussions, weekly meetings, and aid in claims issue resolution.

· Accurately review, investigate, and confirm coverage to appropriately process medical claims and identify key components of processing requirements based on contracts, policies and procedures

· Lead team in testing claims and system configurations.

· Play a key role in helping develop team members to perform at their highest level by offering coaching opportunities, sharing expertise and best practices, offering on the spot feedback and celebrating achievements.

· Review claims queues and provide expertise to address nuances with appropriate parties.

· Collaborate with QA team to determine necessary updates to department processes and procedures to improve departmental quality and efficiency.

· Complete necessary productivity requirements set forth by leadership to meet necessary team and department goals. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.

· Play a key role in the development of departmental workflows and processing procedures.

· Facilitate department specific training and continuation of educational training. 

· Communicate complex claims issues clearly through documentation and direct communications.

· Ability to utilize multiple applications to fulfill all job functions proficiently.

· Ability to create trusting relationships with your peers and those that work closely with you by providing honest and deliberate feedback to achieve departmental goals.

· Comfortable with delivering process updates, department goals, and instruction in a group setting.

· Demonstrate professionalism and lead by example in an environment that is ever-changing and developing.

You bring: 

· High School Diploma

· 4 + years of experience processing/adjusting and/or analyzing medical claims.

· Strong knowledge of CPT/HCPC and ICD-10 code rules.

· Previous experience leading a team in a healthcare setting.

· Ability to set priorities, manage time and work independently.

· Previous experience using Javelina processing system.

· Basic proficiency using Windows based other computer applications.

· Functional comfort with Zoom, Microsoft Teams, or Google Meets

· General knowledge of CMS claims submission regulations

· Demonstrated success getting results through collaboration.

Extra credit: 

· Medical Coding experience/ Certification

· Medical Billing experience

· Understanding of provider data

· Previous start-up company experience

· Degree in Healthcare Administration or similar field

· Previous experience training and creating processes and procedures.

Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.