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Centivo is building affordable, high-quality healthcare solutions for workers and employers. As a Claims Business Analyst, you will serve as a critical operational leader for the Claims team, bridging business needs with technical solutions.
You will triage and resolve operational issues using your claims adjudication and TPA background, working with systems like Javelina and HealthRules Payer. Key responsibilities include:
• Troubleshoot claims issues, identify root causes, and recommend solutions
• Develop advanced reporting, dashboards, and KPIs to support operational decision-making
• Analyze daily, weekly, and monthly operational reports to monitor performance and identify trends
• Act as liaison between business and technical teams during client implementations and system upgrades
• Lead projects to improve Claims team efficiency using data analytics
• Collaborate with vendors and internal stakeholders on requirements, testing, and enhancements
• Query data and create reports to support analysis of claims performance and trends
• Participate in user acceptance testing and technology assessments
• Facilitate brainstorming sessions and process flow documentation
You will work across all business units and external vendors, ensuring seamless integration between internal and vendor systems. This role combines operational problem-solving with analytical rigor—identifying improvement opportunities, scoping initiatives, and driving projects to completion.
Required: 5+ years healthcare claims experience, 3+ years as a Business Analyst, and hands-on experience with automated claim adjudication systems. Understanding of self-funded health insurance environments is essential.
Preferred: Experience with El Dorado-Javelina or HealthRules Payer, TPA background, SQL, Tableau, JIRA, and advanced Excel skills.
