Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
May 7, 2026
Full Job Description
đź“‹ Description
- • The Claims Quality Auditor ensures accurate and correct processing of medical claims based on contractual obligations and regulatory requirements, supporting Gravie’s ability to process claims correctly the first time by identifying trouble spots, root causes, and process gaps.
- • Day to day, the role involves conducting pre-payment, post-payment, and auto-adjudication audits on routine to moderately complex claims across multiple benefit plan designs; verifying payment and financial accuracy against SPDs, regulations, and SOPs; tracking and reporting audit results; identifying and verifying corrections; escalating trends for root cause analysis; researching claim errors to improve guidelines; partnering with system SMEs on systemic issues; participating in cross-functional quality committees; supporting system upgrade testing; assisting in client external audits; and contributing to policy creation, training, and mentoring via quality improvement plans.
- • Gravie is a mission-driven company focused on creating a more equitable and sustainable future for employer-sponsored health insurance, founded and led by industry veterans, backed by top-tier investors, and known for high client satisfaction (above 80%, nearly 40 points above industry average). The culture is non-hierarchical, merit-driven, opinionated but kind, and values authenticity, curiosity, creativity, empathy, and outcomes in a high-performance, fast-paced environment.
- • In this role, the individual can develop deep expertise in medical claims auditing and payment integrity, influence process improvements across the organization, gain exposure to cross-functional initiatives and system upgrades, build leadership and mentoring skills through training others, and contribute meaningfully to a company that values innovation and impact in healthcare.
🎯 Requirements
- • Bachelor’s Degree or equivalent work experience
- • 2 years of experience auditing medical claims for a health insurer or TPA
- • Extensive (5 years) medical claims processing background
- • Ability to analyze data and recognize trends; use of the 5 Whys to determine root cause
- • Strong communication and collaboration skills with proven ability to get results through teamwork
🏖️ Benefits
- • Alternative medicine coverage as part of a unique total rewards package
- • Generous PTO and up to 16 weeks paid parental leave
- • Education reimbursement and paid paw-ternity leave
- • 401k program and transportation perks
- • Opportunities for career growth in a mission-driven, high-performance culture
Skills & Technologies
About Gravie, Inc.
Gravie is a Minneapolis-based health benefits company founded in 2013 that designs and administers employer-sponsored health plans. Its flagship product, Comfort, is a zero-deductible plan combining self-funding, stop-loss insurance and direct provider contracts to give employees first-dollar coverage while controlling employer costs. The company also offers Individual Market solutions, ICHRA administration and a marketplace for supplemental benefits. Gravie serves mid-market and enterprise clients through its technology platform and member support services, aiming to simplify healthcare purchasing and reduce financial barriers for employees.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
Similar Opportunities
Tire's Easy, LLC
19 days ago
1 month ago
