Claims Supervisor

About the role

Centivo is transforming healthcare for employers and their workers by making high-quality, affordable plans accessible. We are looking for a Claims Supervisor to lead a team of Claims Processors. This role focuses on ensuring accurate and timely claims processing for employer-sponsored health plans.

Key facts

What you'll do

• Understand and apply benefit administration for self-funded healthcare plans.
• Ensure claims are processed and paid according to benefit plans, pricing, and authorizations.
• Manage claims inventory against established service level agreements.
• Train and mentor claims staff on proper application of client benefit plans, quality, and production metrics.
• Create performance plans for staff needing improvement and provide coaching.
• Report on claim inventory, production, turnaround times, and quality metrics to department leaders.
• Develop policies and procedures for benefit plan and claim standard administration.
• Help create operational policies and procedures and monitor staff compliance.
• Positively influence team morale by setting achievable goals and fostering teamwork.
• Establish annual goals for staff aligned with company strategy and personal growth.
• Provide timely and constructive performance feedback.
• Act as a claims liaison for various projects, including system testing.

Requirements

• At least 3 years of experience with self-funded healthcare plans and TPA claims processing.
• At least 3 years of experience supervising a claims team.
• Prior experience with a highly automated and integrated claim adjudication system.
• Strong understanding of insurance policies, claims handling processes, and legal requirements.
• Proven leadership and team management abilities.
• Capability to analyze claims data and make informed decisions.
• Understanding of health insurance benefit administration in a self-funded environment.
• Ability to read and comprehend various forms, documentation, and information.

Nice to have

• Past training experience.
• Experience working at a TPA.
• Experience with HealthRules Payer.

Skills & tools

• HealthRules Payer (preferred)

Practical notes

This role offers the flexibility of a hybrid work model in our Buffalo office or fully remote for candidates outside the Buffalo area. Centivo provides competitive compensation, including equity and bonus opportunities.