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Centivo is a healthcare affordability company on a mission to bring high-quality, affordable healthcare to millions of workers and employers. We are seeking a Claims Supervisor to lead a team of Claims Processors in our Buffalo office, with flexibility to work remotely if not local to the area.
In this role, you will oversee the accurate and efficient processing of claims for employer-sponsored health plans. You'll set productivity benchmarks, enforce quality standards, and drive continuous improvement across the claims processing function. You'll manage claims inventory against service level agreements (SLAs), mentor and coach claims staff on proper benefit plan application, and establish performance improvement plans for underperforming team members.
Key responsibilities include:
- Demonstrating deep knowledge of benefit administration for self-funded healthcare plans
- Ensuring claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
- Managing claims inventory and turnaround times to meet SLAs
- Educating and mentoring claims staff to meet quality and production metrics
- Providing reports to department leaders on inventory, production, turnaround lag, and quality metrics
- Developing policies and procedures for benefit plan and claims administration
- Establishing annual goals for staff aligned with organizational strategy and personal growth
- Serving as a liaison on system implementation and upgrade projects
- Fostering team morale, teamwork, and collaborative problem-solving
You'll collaborate with Quality/Training, System Configuration, and support teams to manage backlog, standardize processes, and resolve issues. You may also oversee appeals, subrogation, and overpayment/refund functions.
Required qualifications: At least 3 years of experience with self-funded health care plans in a TPA (Third-Party Administrator) environment, at least 3 years of supervisory experience managing a claims team, and experience with highly automated and integrated claim adjudication systems. Knowledge of HealthRules Payer is required. You must have a thorough understanding of insurance policies, claims handling processes, legal requirements, and health insurance benefit administration in self-funded environments.
Preferred qualifications include prior training experience and TPA background. Strong leadership, analytical, and communication skills are essential, along with strategic thinking, business acumen, and the ability to work through ambiguity.
