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Senior Claims Analyst



Minneapolis, MN, USA
Posted on Thursday, April 27, 2023
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 Senior Claims Analyst will support, review and adjudicate claims in our best in class claim system. The Senior Claims Analyst will be a subject matter expert capable of thoroughly evaluating, researching, and analyzing claim submissions with a solid knowledge of national claims guidelines. In addition to personally reviewing complex claims, the Senior Claims Analyst 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. The Senior Claims Analyst will also support leadership with inventory management, process development, auditing, and other tasks as assigned.

You will:

  • Support team discussions and aid in team claims issue resolution
  • Support team in testing claims and system configuration
  • Play a key role in helping team members perform at their highest level by offering coaching, sharing expertise and best practices, offering feedback on areas that need improvement, and celebrating achievements
  • Process claims within our claim’s queues, and adjudicate based on claims rules
  • Review pended claims queues and provide expertise to address with appropriate parties
  • Periodic claims and process auditing to improve department outcomes
  • Continually meet department metrics and quality
  • Play a key role in the development of departmental workflows and procedures
  • Facilitate the department specific training and continuation of education training
  • Collaborate with QA team to determine necessary updates to department processes and procedures to improve departmental quality
  • Work with leadership to monitor and report KPI data
  • Communicate complex claims issues clearly through documentation and direct communications
  • Ability to utilize multiple applications to fulfill all job functions

You bring:

  • High School Diploma
  • 5 + years of experience processing/adjusting and/or analyzing medical claims preferably in a TPA environment
  • Strong knowledge of CPT/HCPC and ICD-10 code rules
  • Ability to set priorities, manage time and work independently
  • 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
  • Excellent facilitation and transferable knowledge skills communicating effectively on complex concepts
  • Proven ability to develop and implement medical claims processes
  • Experience in managing and assigning claims inventory

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
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.