SlipstreamJobs tracks this role from the company's public career site. Apply directly on the employer's site.
Centivo is a health plan company on a mission to bring affordable, high-quality healthcare to millions of workers. The company works with self-funded employers ranging from 51 employees to Fortune 500 companies, saving employers 15–30% compared to traditional insurance carriers through a primary care-based ACO model.
As a Benefit Plan Configuration Specialist, you will be responsible for understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate claims processing. You will work to maximize the effectiveness of the claims platform by evaluating current processes, business needs, and system capabilities.
Key responsibilities include:
- Create configuration blueprints from plan documents and plan standards
- Build, validate, and test medical and dental plan benefits and code mapping logic
- Revise plan building and logic when plans are amended
- Build and test auto-adjudication logic for platform integration
- Resolve system issues and manage the core claims platform job list
- Test open jobs on new platform releases and troubleshoot before production deployment
- Develop resolutions and workaround procedures for system problems
- Collaborate with department managers and team leaders to improve efficiency
- Coordinate solutions for system issues that prevent automated processing
- Communicate system changes to other departments and provide training as needed
- Maintain the Plan Building mailbox to research and resolve configuration-related issues
The ideal candidate will be assigned to the Buffalo office with the ability to work from home, making this a hybrid role.
REQUIREMENTS:
Required Skills and Abilities:
- Knowledge of professional and institutional claims adjudication
- Ability to interpret plan documents and amendments and translate benefits to ICD-10, HCPCS, CPT, CDT, and other insurance billing codes
- Exemplary customer service skills with ability to research and resolve configuration-related issues timely and accurately
- Ability to adapt to constantly changing environments
- Strong organizational skills with ability to work independently, problem-solve, and make decisions
- Ability to work in fast-paced, agile environments managing multiple issues under production schedule pressure
- Ability to work collaboratively and influence others across multiple functional teams
- Proficiency in Microsoft Office and web-based software applications
- Ability to learn new proprietary computer systems
Education and Experience:
- Prior experience with highly automated and integrated claims adjudication systems
- Prior startup environment experience is a plus
- Preferred: 4–5 years of health insurance-related Plan Building experience with TPA and Self-Funding processes
- Preferred: Associate's or Bachelor's degree
