Configuration Specialist - Contract Build

Remote

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$60,000 – $70,000Compensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must possess demonstrated ability to identify platform limitations requiring external vendor collaboration, perform contract reviews for configuration accuracy, and analyze claims for pricing accuracy against contract requirements. Exemplary customer service skills, excellent analytical and problem-solving skills, and the ability to work independently and as part of a team are essential. The role requires multitasking, critical thinking, strong attention to detail and accuracy, and the ability to thrive in a fast-paced environment with production schedules and deadlines. Excellent verbal and written communication skills are necessary to convey technical information clearly and understand complex information.

Responsibilities

The Configuration Specialist - Contract Build is responsible for the accurate and timely configuration and maintenance of provider contract and pricing configurations within Centivo’s core systems. This involves interpreting contract terms, setting up fee schedules, and ensuring compliance with regulatory and organizational standards. Key responsibilities include collaborating with network contracting and provider relations teams, configuring pricing mechanisms and fee schedules, coordinating with business units and vendors during client implementations, and ensuring system interfaces meet client and operational needs. The role also includes performing manual pricing, identifying incompatible contracts for external vendor integration, collaborating on contract updates across systems, analyzing claim impact reports for pricing accuracy, completing claim adjustments, performing unit and end-user testing, participating in special projects, and providing technical support and training to team members.

Skills

Provider contract configuration

Pricing configuration

Fee schedule setup

Claims adjudication

Provider payments

Contract interpretation

System interfaces

Test validation

Data integration

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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