The Director of Claims Configuration oversees the configuration of plans and payment logic for claims systems, ensuring efficiency and compliance. They lead a team, collaborate across departments, and drive improvements in claims processes.
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:
The Director, Claims Configuration ensures that plans, benefits, and all aspects of payment logic are accurately translated into the claims systems to support compliant, efficient, and high-quality claims adjudication.
This leader partners closely with Claims Operations, Optimization, Product, Network, Finance, Eligibility & Enrollment, and Technology to ensure configuration supports business strategy, member experience, provider satisfaction, and financial integrity. The Director will build scalable configuration governance, lead a high-performing team, and continuously improve accuracy, speed, and flexibility as Gravie grows.
You will:
· Own the end-to-end claims configuration function, including benefits and plan design, pricing logic, accumulator logic, provider data, edits, networks, and adjudication rules.
· Establish configuration standards, including maintenance of standard codes, naming conventions, and benefit category architecture.
· Create and maintain a user-friendly configuration documentation library in Gravie’s knowledge management system.
· Maintain a well-organized configuration task management system, including user-friendly intake and triage processes, interface to claim audit process, regular prioritization, effort estimation and tracking, complete documentation and regular resource balancing.
· Implement appropriate controls and governance to ensure configuration changes are quality assured, compliant with all regulatory and contractual requirements, and documented to ensure audit readiness.
· Translate product, regulatory, and contractual requirements into scalable and repeatable configuration solutions.
· Serve as the subject matter expert on claims configuration capabilities and limitations, advising leadership on design trade-offs and risks.
· Ensure timely and accurate configuration for new products, clients, renewals, and benefit changes.
· Drive continuous improvement in configuration quality, turnaround time, and defect reduction.
· Partner with Claims Operations to minimize configuration-driven claim errors, rework, andprovider abrasion.
· Support root cause analysis of claims issues tied to configuration and implement corrective actions.
· Collaborate closely with Product, Optimization, Network, Finance, Compliance, Eligibility & Enrollment, and Technology to ensure alignment across upstream and downstream processes.
· Create and maintain a balanced scorecard of cost, quality and time metrics with goals, including plan builds, accumulator updates, and escalation management.
· Support product innovation by enabling new benefit designs and network offerings.
· Partner with Technology on enhancements, automation, testing frameworks, and release management related to systems used for claims processing.
· Lead, coach, and develop a team of claims configuration professionals.
· Define roles, workflows, and capacity models to support scale and growth.
· Support training efforts to ensure configuration knowledge is institutionalized and not person dependent.
· Ensure configurations comply with regulatory requirements, contractual obligations, and internal policies.
· Support audits, quality reviews, and regulatory inquiries related to claims configuration.
· Maintain strong documentation and change management practices to support transparency and traceability.
You bring:
· 8+ years of experience in claims and benefits configuration.
· 3+ years of people leadership experience, preferably in a growing or evolving organization.
· Deep knowledge of medical claims adjudication, benefit design, and claims payment logic.
· Experience working cross-functionally with Product, Network, Finance, and Technology teams.
· Strong analytical, problem-solving, and process improvement skills.
· Ability to operate both strategically and hands-on in a fast-paced, scaling environment.
Extra credit:
· Previous experience at a high growth company.
· Experience in a health insurance, TPA, or similar industry
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 $142,500 - $209,000 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. In addition to base salary, this position is also eligible to participate in Gravie’s annual bonus program. Stock options may also be awarded as part of the compensation package.
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, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave.
A Little More About Us:
At Gravie, we're on a mission to reinvent health benefits for small and midsize businesses—making high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we’re building the future of health benefits to reflect just that.
We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before.
And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative—and we’re just getting started.
At Gravie, we do things differently. We’ll challenge you, and we’ll welcome you challenging us. Good ideas are everyone's job here. You’ll join a team that’s smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve.
If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you.
Top Skills
Claims Management Systems
Configuration Documentation Systems
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