Teams at Centivo

Leads complex cross-functional Commercial initiatives from discovery through implementation, stabilization, and closeout. Responsibilities include project planning, business analysis, requirements gathering, process mapping, workflow improvement, UAT coordination, implementation readiness, documentation, training, and change enablement. The role partners with Sales, Client Success, Implementation, Marketing, Finance, Legal, Product, Operations, and Technology teams to improve commercial processes and scalability.

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.