Teams at Centivo

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.