Jobs at Centivo

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.

Manages employer-sponsored health plan document preparation, review, updates, and submission. Oversees team workloads, client onboarding, plan changes, compliance with ERISA and related regulations, and communication with clients, brokers, vendors, and internal teams. Leads process improvements, trains new hires, verifies eligibility and plan requirements, identifies missing information, and escalates issues. Maintains current knowledge of healthcare benefits regulations and ensures accurate SBC, SPD, SMM, and plan amendment documentation.

Prepare, finalize, and maintain complex employee benefit plan documents, including SBCs, SPDs, and SMMs. Verify eligibility and plan requirements, address compliance and customization inquiries, support client and vendor communications, manage assigned accounts and projects, and assist with training junior team members. The role requires expertise in self-funded health and welfare plans, ERISA and non-ERISA benefits, client management, and applicable federal mandates.

Own and grow strategic national self-funded employer relationships post-implementation; serve as executive-level trusted advisor; lead renewals, performance reviews, and expansion opportunities; coordinate cross-functional teams to ensure high-touch service delivery; produce data-driven insights and customized reporting; mitigate retention risks and resolve high-stakes issues; represent Centivo in sales pursuits and contribute client-informed product strategy.

Lead a portfolio of middle-market self-funded employer clients as primary post-implementation contact. Manage renewals, account health, reporting, issue resolution, cross-functional coordination with implementation, sales, analytics, and third parties to drive retention, satisfaction, and growth.

Provide day-to-day operational support for client accounts: attend client meetings and open enrollment, resolve claims/benefit/enrollment issues, coordinate across internal teams and vendors, maintain client trackers and systems, prepare renewals and plan documents, run ad hoc and client-specific reporting, and support escalations under the Client Success Executive.

Conduct pre- and post-payment claims audits across employer groups and product lines, identify procedural and monetary errors, report findings, verify corrections, escalate trends, support quality improvement plans, and assist with policy, training, and claims processing tasks as needed.

Own and lead Centivo's stop loss and captive product portfolio, defining program structure, pricing, reinsurance, underwriting alignment, and performance management. Build the risk product roadmap, design captive strategy, partner with underwriting/actuarial/finance, translate technical mechanics into operational requirements, and represent products externally to brokers, consultants, and partners.

Triage claims operational issues, lead implementations and improvement projects, coordinate with vendors and business units, build reports/dashboards, run queries and analyze claims data, support testing and claims platform upgrades, and recommend automation and system solutions to improve claims processing.