We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
The Claims Recovery Specialist is responsible for supporting healthcare claims recovery activities, with a primary focus on subrogation, overpayment recoveries, and No Surprises Act (NSA) dispute management. This role partners closely with an assigned third-party vendor and internal stakeholders to research paid claims, gather documentation, coordinate follow-up, manage recovery-related inventory, and ensure internal and regulatory timeframes are met.
The ideal candidate has direct experience in healthcare claims, health plan payer, TPA, or managed care claims operations, including exposure to subrogation, overpayment investigations, and/or NSA-related claim activity. This role requires experience researching paid claims, reviewing claim history, coordinating with internal teams and external partners, and managing multiple cases while meeting required turnaround times. This is a specialized claims operations role and is best suited for candidates with healthcare claims recovery experience rather than general analyst or provider billing backgrounds.
Responsibilities Include:
Prepare and review claim history, supporting documentation and related case materials for overpayment, subrogation, and NSA recovery matters.
Research paid claims and investigate recovery opportunities using available systems, documentation, and internal resources
Communicate recovery interest to assigned vendors and clients; support discussions related to settlement activity and case progression
Facilitate meetings and calls between Centivo, third-party vendors, and clients to obtain final approvals and move cases toward resolution
Adjust claims and document case activity as needed based on overpayment findings, settlement activity, or NSA/subrogation outcomes
Maintain accurate and timely documentation, tracking, and data entry for assigned recovery-related cases
Monitors daily and weekly inventory to ensure internal and regulatory timeframes are met
Identify trends or recurring issues and escalate opportunities for process improvement, quality enhancement, and operational efficiency
Perform other duties as assigned
Qualifications:
Required Skills and Abilities:
Strong verbal and written communication skills; with the ability to explain claim-related and regulatory information clearly and professionally
Strong analytical and problem-solving skills, with the ability to review claim details, identify discrepancies, and determine appropriate next steps
High level of organization and attention to detail in a fast-paced environment with competing priorities
Working knowledge of healthcare claims processes and basic concepts related to subrogation, overpayments, and No Surprises Act disputes
Ability to identify urgent situations, exercise sound judgment, and follow established escalation protocols
Ability to produce clear, accurate, and professional business correspondence
3Ability to manage multiple cases and deadlines while maintaining accuracy and consistency. Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment.
Education and Experience:
High School diploma or equivalent required; Associate degree preferred
At least 1 year of experience in health plan payer, TPA, managed care, or healthcare claims operations
At least 1 year of direct experience in subrogation, overpayment recovery, NSA dispute handling, or related claims recovery work
Additional relevant experience or training may be considered in lieu of formal education.
Preferred Experience:
Experience working with payer-side claims recovery vendors=
Experience handling or supporting No Surprises Act dispute workflows
Experience with claim adjustments, recovery tracking, and regulatory turnaround requirements
Work Location:
Candidates located within commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. All other applicants will be considered for remote positions.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
What We Do
Centivo is a new type of health plan anchored around leading providers of value-based care. Centivo saves self-funded employers 15 percent or more compared to traditional insurance carriers and is easy to use for employers and employees. Our mission is to bring affordable, high-quality healthcare to the millions of working Americans who struggle to pay their healthcare bills. With Centivo, employers can offer their employees affordable and predictable costs, a high-tech member experience, exceptional service, and a range of benefit options including both proprietary primary care-centered ACO models as well as traditional networks.
