What are the responsibilities and job description for the CLAIMS QUALITY AUDITOR position at Gravie?
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.
A Little More About The role :
We're looking for a Claims Quality Auditor. This role will ensure the accurate and correct processing of medical claims, based on contractual obligations and regulatory requirements. The Claims Quality Auditor is tenacious in supporting Gravie's ability to process claims correctly, the first time. This entails finding potential trouble spots, identifying root cause and shutting down all gaps and process adherence issues to prevent those trouble spots from persisting.
You will :
- Conduct routine to moderately complex audits, covering multiple benefit plan designs, comparing claims results against SPDs, regulatory requirements, and departmental procedures.
- Research claim processing problems and errors to determine their origin and appropriate resolution.
- Meticulously track and trend audit results, providing regular feedback to management.
- Partner with system SMEs to identify and report on systemic issues which create ongoing quality concerns.
- Conduct audits of claims payments to ensure payments are being issued timely and accurately.
- Serve on applicable cross-functional quality committees and work groups to identify and communicate common quality issues, trends, and patterns.
- Support testing efforts for claims system upgrades, as needed.
- Participate in client external audits.
- Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.
You bring :
Extra credit :
Gravie :
In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.
The salary range for this position is $56,008 - $93,047 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation.
Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie's package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave.
A Little More About Us :
Salary : $56,008 - $93,047
