Centivo
Claims Manager
Remote. Posted 16 days ago
The role
You will oversee and manage health claims processing for self-funded employer groups. You will manage claim supervisors, subject matter experts, and claims analysts while monitoring productivity goals and quality metrics.
What you will do
- Manage health claims processing for self-funded employer groups
- Directly manage claim supervisors, subject matter experts, and claims analysts
- Set and monitor productivity goals and claim quality metrics
- Manage claim inventory against standard service level agreements
- Educate and mentor claims staff and establish performance plans
- Provide reports to department leaders on inventory, production, and quality
- Create work plans to reduce claim inventory and manage overtime
- Develop and monitor policies and procedures for benefit administration
- Act as a liaison for claims on various projects and system implementations
- May manage vendor and network partners, invoices, and recovery processes
Required qualifications
- Proficient experience in MS Word, Excel, Outlook, and PowerPoint
- Understanding of health insurance benefit administration in a Self-Funded environment
- Strong leadership and team management skills
- Ability to communicate effectively with others
- Abilities with process development and improvement and change management
- Ability to read and understand various forms, documentation, files, and information
- Excellent verbal and written communication skills
- Strong interpersonal skills
- At least 5 years of experience with self-funded health care plans
- Experience in a Third Party Administrator (TPA) environment
- Prior experience with a highly automated and integrated claim adjudication system
Nice to have
- Salesforce experience
- High efficiency with Salesforce tool
- El Dorado-Javelina experience
- Experience Health Rules Payer
- Experience with El Dorado-Javelina
- Advanced proficiency in Excel
- Experience managing Claims inventory
About the company
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare. The company is headquartered in Buffalo, NY.