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.

We’re looking for an experienced Claims Examiner to join our claims team. As Gravie looks to continue its member-centric approach to healthcare, we need experienced examiners to review and adjudicate claims in our best in class claim system. With the many challenges that exist in the world of claims, Gravie offers a great environment for individuals looking to build on their career. Qualified applicants should be able to thoroughly evaluate, research and analyze claim submission, possessing a solid knowledge of national claims guidelines. The position has a competitive salary and allows for flexible hours as well as a flexible work schedule.

You will:

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

· Process product or system-specific claims to ensure timely payments are generated for our members

· Ability to accurately calculate deductibles, out-of-pocket maximums and accumulators to resolve pending claims

· 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.

· Partner with the Quality team for clarity on processes and procedures in order to accurately process difficult claims

· Be open to receiving feedback and able to implement coaching opportunities promptly

· Present complex claims issues clearly through documentation and have direct communication with necessary stakeholders to help improve the department

· Ability to identify, problem solve and find solutions for claim specific issues in a timely manner

· Ability to set priorities, manage time, and work independently with minimal supervision

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

· Ability to critically think and work alongside others to help assist with creating SOP’s to ensure claims are being processed correctly and efficiently

You bring:

· High School Diploma

· 2 + years of experience processing medical claims

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

· Excellent critical thinking and decision-making skills

· Basic proficiency using Windows and 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

· Javelina system processing experience

· Medical Billing experience

· Understanding of provider data

· Previous start-up company experience

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, up to 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.