Senior Configuration Analyst

About the Role

Gravie's innovative approach to healthcare is driven by a diverse group of unique individuals who are passionate about making a difference. As a Senior Configuration Analyst, you will be part of a dynamic team that values authenticity, curiosity, creativity, empathy, and outcome-oriented thinking. Your contributions will have a direct impact on the company's ability to deliver member-centric healthcare solutions that people can actually use.

The configuration team at Gravie is a collaborative and supportive environment where you will have the opportunity to lead, train, and mentor your peers. You will work closely with cross-functional teams during implementations and renewals, developing solutions for plan variations and providing support for complex configuration requests.

What You Will Do

• Analyze benefit plan documents to accurately build benefit categories and adjudication rules, ensuring efficient claims processing
• Develop solutions to automate key claims processing workflows, streamlining the overall configuration process
• Troubleshoot observed defects in the output of the claims configuration process, performing root cause analysis and implementing corrective actions
• Support cross-functional teams during implementations and renewals, developing solutions for plan variations and providing expertise on benefit plan configuration
• Provide training, process development, and peer review/QA support to the configuration team, ensuring consistency and quality in benefit plan configuration
• Collaborate with team members to develop and maintain documentation of accumulators and plan configurations, ensuring compliance with regulatory requirements
• Perform quality reviews, regression, and functional testing in support of configuration changes and application updates, ensuring seamless integration and minimal disruption to services
• Demonstrate commitment to Gravie's core competencies, including being authentic, curious, creative, empathetic, and outcome-oriented in all aspects of your work
• Support special project implementations as required, applying your expertise in benefit plan configuration and claims processing to drive business outcomes
• Create and update policies and procedures related to accumulators and plan configurations, ensuring consistency and compliance with regulatory requirements

What We Are Looking For

• 3+ years of experience configuring accumulators and benefit plans or related experience in payer business logic
• 5+ years of experience as a claims examiner, coder, or other related experience working with medical claims data
• Knowledge and experience with adjudication processes, analyzing plan designs, and health plan information systems and applications
• Familiarity with self-funded, level-funded plan designs and the ability to set priorities, manage time, and work independently
• Demonstrated success in collaborating with cross-functional teams to achieve business outcomes, with a strong focus on results-driven thinking
• Ability to analyze complex benefit plan documents and develop creative solutions to automate claims processing workflows
• Experience with coding systems, including CPT/HCPCS, ICD, and DRG, and the ability to apply this knowledge in a fast-paced, dynamic environment
• Strong analytical and problem-solving skills, with the ability to perform root cause analysis and implement corrective actions

Nice to Have

• Familiarity with claims processing software, such as mPhasis, Eldorado, or Javelina
• Working knowledge of EDI formats, including 837/835 claims and 270/271 eligibility
• Experience working in rapidly-growing start-up business environments, with a strong ability to adapt to changing priorities and deadlines
• Understanding of file types A37, 270, 271, 276, 277, and 278, and the ability to apply this knowledge in a practical context

Benefits and Perks

• Competitive salary and benefits package, with a focus on supporting your overall well-being and quality of life
• Opportunity to work with a dynamic, innovative company that is changing the face of healthcare
• Collaborative, supportive work environment with a strong focus on teamwork and open communication
• Professional development opportunities, including training and mentorship programs to help you achieve your career goals
• Flexible, remote work arrangements, allowing you to work from anywhere and maintain a healthy work-life balance
• Access to cutting-edge technology and tools, enabling you to stay up-to-date with the latest developments in the industry
• Recognition and rewards for outstanding performance, including bonuses and other incentives
• Comprehensive health insurance and wellness programs, supporting your physical and mental health
• Generous PTO and vacation time, allowing you to recharge and pursue your passions
• Retirement savings plan and other benefits, providing peace of mind and financial security for the future

• Tip: When applying, be sure to highlight your experience with benefit plan configuration and claims processing, as well as your ability to work independently and collaborate with cross-functional teams.
• To stand out, emphasize your knowledge of coding systems, including CPT/HCPCS, ICD, and DRG, and your experience with claims processing software.
• Be prepared to provide specific examples of your experience with adjudication processes and plan design analysis, and to explain how you have applied this knowledge in a practical context.
• When negotiating salary, be sure to research the market rate for Senior Configuration Analysts in the healthcare industry and to highlight your unique skills and experience.
• Red flag: Be wary of companies that do not provide clear information about their benefits and perks, or that seem unclear about their expectations for the role.
• Tip: Be sure to ask about opportunities for professional development and growth within the company, and to inquire about the team's dynamics and culture.