Gravie · 1 day ago
Director, Claims Configuration
United States
Full-time
Remote
Senior Level, Lead/Staff
$142K/yr - $209K/yr
8+ years expGravie is on a mission to improve healthcare access through innovative health benefit solutions. The Director of Claims Configuration will oversee the claims configuration function, ensuring compliance and efficiency in claims adjudication while collaborating with various departments to support business strategy and enhance member experience.
Employee BenefitsHealth CareInsuranceInsurTech
Responsibilities
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, including user-friendly intake and triage processes, interface to claim audit process, regular prioritization, effort estimation and tracking, complete documentation and regular resource balancing
Implement appropriate controls and governance to ensure configuration changes are quality assured, compliant with all regulatory and contractual requirements, and documented to ensure audit readiness
Translate product, regulatory, and contractual requirements into scalable and repeatable configuration solutions
Serve as the subject matter expert on claims configuration capabilities and limitations, advising leadership on design trade-offs and risks
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, rework, and provider abrasion
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 to ensure alignment across upstream and downstream processes
Create and maintain a balanced scorecard of cost, quality and time metrics with goals, including plan builds, accumulator updates, and escalation management
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 and not person dependent
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
Qualification
Required
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
Preferred
Previous experience at a high growth company
Experience in a health insurance, TPA, or similar industry
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
Company
Gravie
Gravie is an insurance company that designs health benefits plans for small and midsize employers.
201-500 employees
Funding
Current Stage
Late StageTotal Funding
$532.62MKey Investors
Trinity CapitalGeneral AtlanticGeorgian
2025-06-01Private Equity· $150M
2024-06-25Debt Financing· $40M
2023-03-21Private Equity· $179M
Leadership Team
Charles Marentette
CFO
Amy Spartz
Chief People Officer
Recent News
2025-08-08
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2025-08-08
Coverager - Insurance news and insights
2025-04-23
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