Responsible for managing payment integrity for healthcare claims, creating roadmaps, defining requirements, and evaluating vendor performance, ensuring compliance and effective collaboration across teams.
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:
We’re looking for a Product Manager, Payment Integrity to create and deliver a roadmap of investments in payment integrity capabilities such as code editing, bill review, fraud / waste / abuse detection, subrogation, and coordination of benefits to ensure Gravie pays all medical claims correctly. You will be responsible for creating and prioritizing a Payment Integrity roadmap; defining requirements; identifying and evaluating potential vendors for prioritized capabilities; creating user stories for internally developed capabilities and components; partnering with operations, product, and project management; and maintaining a dashboard of Payment Integrity performance.
You will:
● Maintain a roadmap of investments in internally developed capabilities and vendor solutions in key areas that impact the accurate payment of medical claims, such as claim / code editing, hospital bill review, DRG validation, fraud / waste / abuse detection, subrogation, and coordination of benefits
● Create systems that maximize the identification and adjustment of incorrect claims prior to payment without exceeding timely payment and other operational performance requirements
● Define operational and financial goals in each payment integrity domain, aggregate data to evaluate performance against these goals, and regularly publish and verbally communicate performance updates
● Regularly review the performance of each vendor and internally developed capability relative to internal and external benchmarks; iterate decisively when performance deficits or upside opportunities are identified
● Keep current on industry innovations, standards and regulations to ensure all payment integrity solutions are strictly compliant with applicable regulations and consistent with industry best practices
● Collaborate with operations, finance, and legal to develop implementable solutions
● Perform other duties as assigned
You bring:
● 5+ years of experience in health care product management, consulting, or other similar role collaborating with product managers, operators, financial leaders, engineers, and other functions
● 2+ years of experience managing structured prioritization processes
● Experience with healthcare data, including claims, EDI transactions, and coding standards
● Experience with health plan and provider network concepts
● Bachelors degree
Extra credit:
● Experience with payment integrity, revenue cycle management, or health plan / payer operations and claims processing
● Proficiency with tools such as Jira and other backlog or project tracking platforms
● Experience managing third-party vendor relationships
● Comfort working with both highly technical users (e.g., engineers) and non-technical stakeholders (e.g., Finance, Operations)
● Strong project management skills including timeline management and prioritization using Agile methodologies (e.g., Scrum)
● Understanding of the complete Software Development Lifecycle (SDLC), especially in ambiguous or shifting problem spaces
● Self-starter mindset with the ability to independently achieve defined goals
● Proven ability to motivate and influence cross-functional teams without direct authority
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 $101,600 - $169,300 annually. Numerous factors including, but not limited to, education, skills, work experience, certifications, etc. will be considered when determining compensation. 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, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave.
A Little More About Us:
● We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
● We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
● Our customers like us. Our revenue churn is in the low single digits, in an industry where greater than 20% churn is common.
● Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way.
Top Skills
Agile Methodologies
JIRA
Software Development Lifecycle (Sdlc)
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