Jobs at Centivo

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.

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.

The Claims Compliance Manager oversees compliance reporting for health plan products, ensures adherence to regulatory requirements, and manages operational workflows in a fast-paced environment.

Design, document, test, and maintain end-to-end claims workflows and Confluence documentation. Build training materials and deliver instructor-led or virtual sessions, validate workflows in Javelina and HRP, support onboarding, and partner cross-functionally to ensure claims processes function as designed and remain accessible and accurate.

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.