About The Position
Hi, we’re Gravie. We improve the way employers offer health benefits and provide employees coverage they can actually use. We’re looking for a TPA Specialist, responsible for end to end TPA duties including new group set up, eligibility and enrollment, claims and appeals, and researching questions and issues. This position also helps Gravie scale by ensuring thorough documentation and processes are in place while continuously being on the lookout for opportunities to innovate and improve our members' experience. This position works collaboratively with all departments and our vendor partners, and will be involved in finding ways to put our product innovations into motion.
● Set up new groups within Gravie’s systems and with our network and vendor partners
● Ensure member eligibility requirements are met, resolving any questions or discrepancies that are raised
● Ensure eligibility files are successfully transferred to our vendor partners and work to resolve any issues that arise
● Collaborate with other departments to provide information and quickly resolve customer inquiries or issues.
● Help ensure claims processing runs smoothly and researching and resolving questions about payments, recoupments, denials, adjustments, appeals and adverse benefit determinations
● Work closely with providers to ensure our members are served quickly and accurately
● Prepare reports by collecting, analyzing, and summarizing information
● Read and interpret plan information such as Summary Plan Documents and Summary of Benefits Coverage and other documentation
● Partner with compliance to ensure our practices and actions adhere to regulatory requirements
● Help other departments and the company be successful by providing subject matter expertise, training and guidance on TPA practices.
● Demonstrate Gravie’s core competencies of authenticity, curiosity, creativity, empathy and outcome orientation
● At least 5 years of previous experience with a TPA or health insurance carrier
● Expertise in health insurance administration including eligibility and enrollment, network requirements and claims adjudication
● A sense of urgency when serving our members and resolving questions or problems
● Really, really strong attention to detail and organization skills
● Ability to have several projects going on at once and prioritize your work as situations change
● Good judgment and decision making skills and the ability to work independently
● Energy and a positive approach to finding creative ways to solve problems, and helping others do the same
● Previous success establishing processes and training and helping others be successful
● Flexibility in working from home or in the office
● Knowledge of stop loss claims processing
● Experience with Individual Coverage Health Reimbursement Arrangements - ICHRA
This position is exempt.