Centivo Claims Manager at Centivo oversees health claims processing for self-funded employer groups, managing claims staff and ensuring quality and productivity goals. The role collaborates across teams to resolve dependencies and enforce policies.
Responsibilities
Working under guidance of the Director- Claims Management, you will:
Demonstrate knowledge and understanding of benefit administration for self-funded healthcare plans
Directly support the client relationship and implementation process by being a collaborative partner with teams responsible for client facing issue resolution
May be a direct point of contact for clients, vendors or providers that require relationship owners
Ensure that metrics are established and monitored to ensure claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
Manage the inventory of claims against standard service level agreements (SLA’s)
Educate and mentors claims staff and to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement
Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
Create work plans to reduce claim inventory, including management of over-time hours that are appropriately monitored for cost effectiveness
Develop policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
Qualification
Proficient experience in MS WordSalesforce experience is a plusStrong interpersonal skillsAdvanced proficiency in ExcelExperience managing Claims inventoryRemote available for a strong fitResilient – This is wicked hardPositive – We care about each other
Required
Proficient experience in MS Word, Excel, Outlook, and PowerPoint required
Salesforce experience is a plus, high efficiency with tool is a bonus
Understanding of health insurance benefit administration in a Self-Funded environment
Strong leadership and team management skills, with the ability to communicate effectively with others
Demonstrate abilities with process development and improvement as well as change management
Ability to read and understand various forms, documentation, files, and information with the department
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards
Strong interpersonal skills, establishing rapport and working well with others
At least 5 years of experience with self-funded health care plans, and experience in a Third Party Administrator (TPA) environment
Preferred
Experience Health Rules Payer and/or El Dorado-Javelina
Advanced proficiency in Excel
Experience managing Claims inventory
An ideal candidate would be assigned to the Buffalo Office with ability to work from home
Remote available for a strong fit
Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.
Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.
