Job Overview
Location
Indiana, USA
Job Type
Full-time
Category
Operations Manager
Date Posted
February 27, 2026
Full Job Description
đź“‹ Description
- • Gravie is seeking a visionary and results-driven Vice President, Claims to spearhead our Health Plan Operations team. This pivotal role is instrumental in shaping the future of health benefits by leading the design, operation, and optimization of our benefit configuration, claim adjudication, and provider payment functions. You will be at the forefront of developing and executing strategic initiatives aimed at enhancing the cost-effectiveness, quality, and overall efficiency of Gravie’s health plans. This includes the seamless integration of new provider networks and the continuous improvement of our payment integrity programs, ensuring Gravie delivers on its promise of health benefits that everyone can love.
- • As the Vice President, Claims, you will be responsible for the comprehensive, end-to-end processing of both medical and pharmacy claims. This encompasses the entire lifecycle from claim receipt through to final payment, including the meticulous handling of appeals and complex escalations. Your leadership will ensure that all operations adhere strictly to contractual agreements, plan documents, and all applicable regulatory requirements, maintaining the highest standards of compliance and integrity.
- • Leveraging data will be central to your role. You will utilize analytical insights to gain a deep understanding of all facets of the claims operation. This data-driven approach will enable you to efficiently match supply with demand throughout the claims process, identify critical synergies between various workflows, and proactively eliminate unnecessary, redundant, or inefficient work. Your objective is to drive continuous improvement and operational excellence.
- • You will be tasked with creating and maintaining robust process flows and standard operating procedures (SOPs). These documented guidelines are essential for ensuring reliable, consistent, and high-quality execution of all claims-related activities, providing a solid foundation for operational stability and scalability.
- • A key aspect of this role involves providing critical business requirements and offering cross-functional support to the technology teams responsible for building and enhancing Gravie’s proprietary technology applications. Your input will directly influence the development of tools and systems that streamline and optimize our claims processing capabilities.
- • You will play a crucial role in supporting the creation of new and innovative health benefit plans. This includes developing forward-thinking and efficient methods for delivering Gravie’s unique value proposition, ensuring our offerings are not only competitive but also exceptionally beneficial to our clients and their employees.
- • You will establish and refine processes for identifying gaps in processes, systems, and policies that impact the timeliness, quality, or efficiency of our claims operations. This involves diagnosing root causes, understanding contributing factors, and architecting effective, sustainable solutions that address these challenges comprehensively.
- • Close collaboration with the leadership of our Gravie Care member service operation is essential. You will partner to ensure that escalation workflows are optimally designed and effectively operated. Furthermore, you will ensure that our knowledge bases and training materials are consistently accurate, up-to-date, and easily digestible for the member service team, fostering a seamless member experience.
- • A deep understanding of the regulatory landscape is paramount. You will possess extensive knowledge of compliance requirements related to self- and level-funded health plans, as well as other components of employer health benefits offerings, including HRAs, HSAs, FSAs, dental, vision, and wellness benefits.
- • You will be responsible for developing and communicating key performance metrics and business updates. This communication will be delivered both internally within the claims team and across the broader Gravie organization, ensuring transparency and alignment.
- • A significant part of your role will involve people leadership. You will be dedicated to developing your team members, fostering their growth, motivating them, empowering them, and encouraging innovation from every employee. Building a high-performing, engaged team is a core objective.
- • You will construct and maintain a comprehensive model of claims operations tasks. This model will be translated into effective cost-of-service modeling and key metrics, which will be used to drive budgeting decisions, identify cost reduction opportunities, and build compelling business cases for strategic investments.
- • You will embody and champion Gravie’s core competencies: being authentic, curious, empathetic, creative, and outcome-oriented. Your leadership style and daily actions will reflect these values, shaping the culture of the Health Plan Operations team and the company as a whole.
🎯 Requirements
- • 15+ years of progressive experience in health plan operations, preferably within a Third-Party Administrator (TPA) or insurance carrier environment, with a profound understanding of self- and level-funded plans.
- • Proven ability to lead, mentor, and develop front-line supervisors and managers, coupled with a willingness and capacity to dive in and directly contribute to key initiatives.
- • Deep subject matter expertise in medical claims processing, including adjudication, payment integrity, and related operational workflows.
- • Demonstrated success in project planning, execution, and delivering measurable results through collaborative efforts.
- • Working knowledge of network and provider contracts, including understanding their implications on claims processing and payment.
- • Excellent verbal and written communication skills, with the ability to articulate complex information clearly and persuasively to diverse audiences.
🏖️ Benefits
- • Competitive salary range ($214,125 – 314,050 annually) plus eligibility for annual bonus program and potential stock options.
- • Comprehensive health and wellness benefits, including alternative medicine coverage.
- • Generous Paid Time Off (PTO), up to 16 weeks of paid parental leave, and paid holidays.
- • 401k program with company match.
- • Additional perks such as transportation benefits, education reimbursement, and paid paw-ternity leave.
Skills & Technologies
Remote
$214k-314k
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.
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