Full-Time Director of Claims Payment & Payment Integrity Operations

• Maintain efficient and accurate processes for claims payments and payment integrity.
• Implement processes, technologies and potentially vendor relationships to increase the timeliness and completeness of Gravie's recoupment of balances owed by providers.
• Ensure the claims payment, payment integrity, and balance recoupment processes meet all regulatory standards and contractual requirements.
• Manage relationships with third-party vendors and partners.
• Work closely with claims operations, optimization, clinical, and finance teams to implement innovative solutions and resolve complex issues.
• Implement and maintain robust risk management strategies to protect the organization from fraud and other risks.
• Lead, mentor, and develop a team, fostering a culture of accountability and continuous improvement.

• Bachelor's degree or equivalent experience.
• 8+ years of experience in healthcare claims and payments.
• 3+ years of team management experience.
• Deep understanding of applicable regulatory requirements.
• Strong understanding of health insurance payment integrity best practices.
• Ability to make strategic decisions, plans, and actions based on data.
• Proven leadership and management skills.
• Strong analytical, problem-solving, and strategic planning skills.
• Excellent verbal and written communication and interpersonal skills.
• Demonstrated success getting results through collaboration.

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