[Remote] Claims Processor at Centivo

Remote

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Prior experience with a highly automated and integrated claims processing system
Experience working with HealthRules Payer preferred
Knowledgeable about healthcare claims, medical coding, and rules applicable to Benefit Plans
Strong critical thinking skills and willingness to make independent decisions with little supervision
Excellent oral and written communication skills
Proven ability to work in a fast-paced environment, managing multiple issues with pressure of production schedules and deadlines
Proven ability to work independently for majority of day
Proficiency in Microsoft Office applications and other web-based software applications
Ability to work independently for majority of day
Experience with automated systems and processes

Responsibilities

Manage and process healthcare claims for self-funded employer groups
Review and assess claims, adjudicate payment to providers on behalf of the Plan
Work closely with Claims Supervisor, Account Managers, System Configuration and Quality Assurance Team
Ensure claims are adjudicated in a timely manner and accurately
Review system-generated edits and apply benefits as per client's Summary Plan Documents (SPDs)
Route claims to Plan Build/System Configuration Team for resolution when necessary
Route claims to Provider Maintenance and/or Pricing teams for resolution when necessary
Deny claims for additional information and generate correspondence to participants or providers
Maintain daily, weekly, and monthly required production levels
Participate in Departmental quality improvement efforts and bring forward process improvement suggestions

Skills

Key technologies and capabilities for this role

Claims AdjudicationPolicy InterpretationData AnalysisProblem-solvingCommunication

Questions & Answers

Common questions about this position

Is this Claims Processor position remote?

Yes, the position is fully remote.

What does a Claims Processor do at Centivo?

Claims Processors adjudicate healthcare claims in assigned queues based on policies, procedures, and Summary Plan Documents, review system edits, route issues to appropriate teams, deny claims needing more info, and meet production and quality goals.

Is training provided for the Claims Processor role?

Yes, Centivo provides a paid training program scheduled to start Monday, December 8, 2025.

What teams does a Claims Processor work with?

Claims Processors work closely with the Claims Supervisor, Account Managers, System Configuration, Quality Assurance, Provider Maintenance, and Pricing teams.

What is the salary for the Claims Processor position?

This information is not specified in the job description.

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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