Claims Supervisor at Centivo

Buffalo, New York, United States

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$70,000 – $80,000Compensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims
Strong leadership and team management skills, with the ability to effectively manage and motivate a team
Ability to analyze claims data and make informed decisions based on findings
Previous experience in claims processing or a related field, including supervisory experience
Understands health insurance benefit administration in a Self-Funded environment
Ability to read and understand various forms, documentation, files, and information with the department
At least 3 years of experience with self-funded health care plans, and processing in a TPA environment
At least 3 years of experience supervising a claims team
Prior experience with a highly automated and integrated claim adjudication system
Experience working with HealthRules Payer
Preferred: Past Training Experience
Preferred: Experience working at TPA
Preferred: Experience with self-funded plans
Leadership skills including strategic thinking

Responsibilities

Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
Manages the inventory of claims against standard service level agreements (SLAs)
Educates and mentors claims staff 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
Develops 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
Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
Performs other duties as deemed essential and necessary

Skills

Key technologies and capabilities for this role

Claims ProcessingBenefit AdministrationSelf-Funded Healthcare PlansSLA ManagementTeam LeadershipQuality AssurancePerformance MetricsMentoringPolicy DevelopmentCompliance

Questions & Answers

Common questions about this position

What is the salary range for the Claims Supervisor position?

The salary range is $70K - $80K.

Is this a remote, hybrid, or on-site role?

This is a hybrid position.

What key skills are required for the Claims Supervisor role?

Required skills include thorough understanding of insurance policies, claims handling processes, and legal requirements; strong leadership and team management skills; analytical skills to analyze claims data; previous experience in claims processing with supervisory experience; and understanding of health insurance benefit administration in a self-funded environment.

What is the company culture like at Centivo?

Centivo focuses on positively influencing department morale by setting achievable goals, fostering teamwork, involving the team in problem-solving, and providing timely constructive feedback aligned with organizational strategies and personal growth.

What makes a strong candidate for this Claims Supervisor position?

A strong candidate will have supervisory experience in claims processing, thorough knowledge of insurance policies and self-funded health plans, strong leadership to motivate teams, and analytical skills for data-driven decisions.

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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