Director, Claims Operations — Automation & Quality Leader

Gravie; Minneapolis (MN); On-site; USD 140,000 - 210,000; Full time

Benefits offered by this job

Alternative medicine coverage

Flexible PTO

Parental leave (16 weeks)

Paid holidays

401k program

Transportation perks

Education reimbursement

Paw-ternity leave

Job summary

Gravie is seeking a Director of Claims Operations to lead end-to-end claims processing, stop loss management, and payments with a focus on automation and quality. You will manage multiple teams, drive improvements, and ensure regulatory compliance across all claims activities.

The role emphasizes ownership, accountability, and building a high-performance culture within a fast-paced healthcare benefits company.

Qualifications

• Bachelor's degree or commensurate experience.
• 8+ years of experience in healthcare claims operations.
• 3+ years leading managers and teams.
• Strong knowledge of claims adjudication logic and stop loss mechanics.
• Experience automating manual workflows and improving processes.
• Ability to establish clear decision rights and operating norms.

Responsibilities

• Own the full claims processing lifecycle across all stages: first pass, adjustments, stop loss, support, appeals, and payments.
• Lead a team of Claims Managers and a payments team, fostering accountability and growth.
• Drive automation, process improvements, and operational readiness with cross-functional partners.
• Ensure compliance with regulatory and contractual requirements and manage vendor performance.
• Collaborate with Finance, Sales, Account Management, and Clinical teams for cross-functional alignment.

Skills

Claims operations

Leadership

Automation

EDI workflows

Adjudication logic

Vendor management

Regulatory compliance

Education

Bachelor's degree or commensurate experience

Tools

Claims platforms

EDI

Job description

Gravie is seeking a Director of Claims Operations to lead end-to-end claims processing, stop loss management, and payments with a focus on automation and quality. You will manage multiple teams, drive improvements, and ensure regulatory compliance across all claims activities.

The role emphasizes ownership, accountability, and building a high-performance culture within a fast-paced healthcare benefits company.