Claims Business Analyst

Remote

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$80,000 – $100,000Compensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates should possess claims adjudication experience and a TPA background. Familiarity with Centivo’s claims systems (Javelina and HealthRules Payer) is preferred. Advanced problem-solving, organizational, and decision-making skills are essential, along with the ability to work independently and collaboratively in a fast-paced environment. Proficiency in Microsoft Office and web-based applications, as well as experience running queries and performing data analysis, are required. Excellent verbal and written communication skills are also necessary.

Responsibilities

The Claims Business Analyst will triage operational issues, lead projects to completion, and coordinate with business units and external vendors during client implementations. This role involves ensuring seamless integration between internal and vendor systems, identifying areas for improvement through data analytics, and leading projects to enhance the efficiency of the Claims team. Responsibilities include supporting the Claims Team with troubleshooting, creating process flows, acting as a liaison between business and technical resources, facilitating brainstorming sessions, assisting with claims testing, staying updated on vendor enhancements, collaborating with SMEs, overseeing claims platform upgrades, identifying system solutions for automation and efficiency, assessing new technologies and vendors, participating in meetings for plan design and strategy, and querying data to support analysis of claims performance.

Skills

Claims Adjudication

TPA Background

Javelina

HealthRules Payer

Data Analytics

Process Flows

Business Requirements

Root Cause Analysis

Vendor Management

Client Implementations

Centivo

Affordable health insurance with primary care focus

About Centivo

Centivo provides health insurance focused on making healthcare affordable and accessible. The company emphasizes primary care, offering free primary care services, no deductibles, and low, predictable copays to help keep its members healthier and reduce the need for hospital visits. Centivo generates revenue by charging employers for health plans provided to their employees, which leads to lower medical costs and increased usage of the plans. A key feature of Centivo's offering is its integrated virtual care service, allowing members to access care conveniently. The company is distinguished by its commitment to quality, curating providers based on strict price and quality standards, particularly in primary care. Centivo's goal is to enhance the member experience while lowering overall healthcare costs.

Buffalo, New YorkHeadquarters

2017Year Founded

$183.7MTotal Funding

DEBTCompany Stage

Financial Services, HealthcareIndustries

201-500Employees

Benefits

Insurance: Medical, dental, vision, life & diability

401k plan

Access to a health savings account

Commuting and dependent care FSA

Competitive salary, bonus, & equity

Risks

Integration challenges with Eden Health may disrupt service delivery if not managed well.

Chronic shortages in primary care access could impact Centivo's care delivery model.

Increased competition from AI-driven startups may challenge Centivo's market position.

Differentiation

Centivo emphasizes primary care partnerships to coordinate healthcare needs effectively.

The company offers free primary care, no deductibles, and low, predictable copays.

Centivo integrates virtual care and mental health services for comprehensive healthcare solutions.

Upsides

Centivo raised $75M to expand affordable health plans amid rising U.S. healthcare costs.

Acquisition of Eden Health enhances Centivo's virtual care and mental health services.

Growing trend of virtual care aligns with Centivo's integrated virtual care service.

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