[Remote] Client Operations Specialist at Centivo

Remote

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$60,000 – $65,000Compensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Experience working with health insurance products (HMO, PPO, HDHP, etc.), funding types (fully insured, ASO, Level Funded), and regulations (ACA, HIPAA)
Strong organizational and project management skills
Proficiency with MS Office (Excel, Outlook, Word)
Excellent written and verbal communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Holds high Customer Service standards and aims to be client-orientated with a drive for quality

Responsibilities

Act as Subject Matter Expert, representing the voice of the customer and client success, on any product, network, vendor discussions and rollouts
Identify Client Success needs and requirements related to such rollouts, ensuring timely distribution of deliverables to Client Success
Support Open Enrollment, Plan Renewals and any plan changes
Provide project management and system support for internal systems (Plan Manager, Portal)
Ensure accuracy and integrity of client data in internal systems
Monitor KPIs related to client satisfaction, service level agreements (SLAs), and operational performance
Alert Client Success if KPIs are not meeting targets and make recommendations to improve performance
Identify inefficiencies in client-facing processes and propose solutions
Develop and maintain standard operating procedures (SOPs)
Partner with all areas of the organization, including but not limited to: Client Success, Account Management, Product, and IT, to ensure consistent delivery of outputs
Assist with any broad claims issues when necessary
Identify issue impact and communicate root causes and resolution steps clearly to client success, while also working with Communications on external communication if/when necessary
Handle client inquiries by collaborating with Claims and Member Care departments to resolve and/or escalate member issues, including VIP member issues with internal Customer Advocacy team
Provide timely updates on system changes, process impacts, or service issues/outages
Own the intake, tracking, and resolution of broad operational client issues (e.g., file failures, processing delays, network changes, etc.)
Log, track, and resolve escalations by coordinating with internal departments like claims, IT, eligibility, etc
Identify issue impact and communicate root causes and resolution steps clearly to client success
Support Client Success with integration of third-party vendors for clients (e.g., PBM, eligibility vendors, point solutions, etc.)
Facilitate internal process including requirement gathering, ticket submission and monitoring

Skills

Project Management

Data Management

Reporting

KPI Monitoring

SLA Management

Process Optimization

SOP Development

Workflow Management

Open Enrollment

Plan Renewals

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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