[Remote] Claims Supervisor - Management Ancillary Support (CMAS) at Centivo

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

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
Understanding of health insurance benefit administration in a Self-Funded environment
Ability to read and understand various forms, documentation, files, and information with the department
5 years or more experience with healthcare claims administration, self-funded preferred
Experience leading and delegating tasks to multiple direct reports
Excellent verbal and written communication skills
Proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail
Proficient experience in MS Word, Excel, and other software

Responsibilities

Oversees and manages the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery
Ensures that claims, appeals, and adjustments are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
Manages the inventory of claims against standard service level agreements (SLA’s)
Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics
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
Monitors claim staff for compliance with policies and procedures
Positively influences the morale of the department employees, including setting achievable goals and fostering teamwork
Establishes annual goals for staff that align with organization strategies and personal growth
Provides timely and constructive feedback on performance
Liaises with the CMAS Team on various projects and/or initiatives, including claims and testing needs to support system implementations and/or upgrades
Performs other duties as deemed essential and necessary

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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