Claims Manager

Job not on LinkedIn

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🗽 New York – Remote

🗽 New York – Remote

💵 $95k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

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Centivo

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Centivo is an innovative health plan provider for self-funded employers that focuses on delivering high-quality healthcare at an affordable cost. The company believes in the power of primary care to improve health outcomes and reduce costs. Centivo offers plans with free primary care, no deductibles, and low, predictable copays, thereby encouraging members to utilize their health benefits without financial burden. The plans are curated to meet stringent price and quality standards, promoting a strong relationship with primary care providers and integrating virtual care options. Centivo's approach is designed to reduce overall medical expenses while enhancing the healthcare experience for both employers and employees.

📋 Description

• Oversee and manage health claims processing for self-funded employer groups • Directly manage claim supervisors, subject matter experts, and Claims Analysts • Set and monitor productivity goals and claims quality metrics • Manage cross-functional dependencies affecting backlog and turnaround-time goals • Collaborate with Quality/Training and System Configuration teams to establish standard processes and mitigate issues • Support client relationships and implementation processes • Serve as a point of contact for clients, vendors, or providers when required • Establish and monitor metrics for claims processing and payment according to benefit plans, pricing agreements, and authorizations • Manage claims inventory against standard service level agreements • Educate and mentor claims staff; establish performance plans and provide coaching • Report claim inventory, production, turnaround lag, and quality metrics to department leaders • Create work plans to reduce claims inventory and monitor overtime for cost effectiveness • Develop and monitor policies and procedures for benefit-plan and claims administration • Foster employee morale, teamwork, goal setting, and professional growth • Establish annual staff goals and provide timely, constructive performance feedback • Liaise on claims-related projects, initiatives, testing, system implementations, and upgrades • Potentially manage vendors and network partners, vendor invoices, overpayment and recovery, subrogation, appeals, pricing strategies, and process improvement • Perform other essential duties

🎯 Requirements

• Proficient experience in MS Word, Excel, Outlook, and PowerPoint • Understanding of health insurance benefit administration in a self-funded environment • Strong leadership and team management skills • Ability to communicate effectively with others • Demonstrated ability with process development, process improvement, and change management • Ability to read and understand various forms, documentation, files, and information within the department • Excellent verbal and written communication skills • Ability to communicate complex or technical information clearly and concisely • Strong interpersonal skills • At least 5 years of experience with self-funded health care plans • Experience in a Third Party Administrator (TPA) environment • Prior experience with a highly automated and integrated claim adjudication system • Salesforce experience is a plus • El Dorado-Javelina experience preferred but not required • Experience with Health Rules Payer and/or El Dorado-Javelina preferred • Advanced proficiency in Excel preferred • Experience managing claims inventory preferred • Must be authorized to work in the United States for any employer • Centivo does not sponsor work authorization visas

🏖️ Benefits

• Equity option grants • Bonus • Health benefits, some employer paid • Paid time off (PTO) • Ability to work from home for remote candidates • Free primary care (including virtual), predictable copay and no-deductible benefit plan design for Centivo-covered employees

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