Centivo Benefits Overview

Leads Centivo’s Claims Management Ancillary Services and Plan Documents functions, overseeing strategy, compliance, quality, performance, workforce planning, and process improvement. Ensures accurate and timely SPDs, SMMs, SBCs, amendments, claims audits, appeals, recoveries, subrogation, and No Surprises Act processes. Manages two functional leaders, develops team performance, monitors operational KPIs, partners cross-functionally, and serves as the operational authority for clients, brokers, TPAs, and stop-loss carriers.

Review and adjudicate healthcare claims per client Summary Plan Documents and Centivo policies. Resolve system edits, route complex issues to configuration/pricing teams, deny and request additional information as needed, meet production and quality targets, support quality improvement, mentor junior staff, and assist with advanced reviews, overpayments, and refunds.

Lead and coach a claims processing team for self-funded employer health plans, enforce SLAs and quality standards, manage claim inventory and backlog, develop policies and procedures, collaborate with Quality/Training and System teams, oversee appeals/subrogation/overpayments, and report performance metrics.