[Hiring] Claims Supervisor @Centivo

Role Description

Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.

The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.

• Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
• Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
• Manages the inventory of claims against standard service level agreements (SLAs)
• Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics
• Establishes performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement
• Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
• Develops policy and procedures to ensure that benefit plans and claim standards are properly administered
• Assists in developing policies and procedures for operations, and monitors claim staff for compliance
• Accountable for positively influencing the morale of the department employees
• Responsible to establish annual goals for staff that align with organization strategies and personal growth
• Acts as a liaison for the claims on various projects and/or initiatives
• Performs other duties as deemed essential and necessary

Qualifications

• Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims
• Strong leadership and team management skills, with the ability to effectively manage and motivate a team
• Ability to analyze claims data and make informed decisions based on findings
• Previous experience in claims processing or a related field, including supervisory experience
• Understands health insurance benefit administration in a Self-Funded environment
• Ability to read and understand various forms, documentation, files, and information with the department

Requirements

• At least 3 years of experience with self-funded health care plans and processing in a TPA environment
• At least 3 years of experience supervising a claims team
• Prior experience with a highly automated and integrated claim adjudication system
• Experience working with HealthRules Payer
• Understanding of health insurance benefits administration in a self-funded environment

Preferred Qualifications

• Past Training Experience
• Experience working at TPA
• Experience with self-funded plans

Work Location

An ideal candidate would be assigned to the Buffalo Office with ability to work from home. If not in the Buffalo area, the opportunity can be remote.

Leadership Skills & Behaviors

• Strategic Thinking: Ability to sort through clutter to find the best route by identifying patterns in complexity
• Business Acumen: Quick understanding and handling of business situations, considering both risks and opportunities
• Systems/Analytical Thinking: Capacity to integrate information, anticipate non-linear and non-obvious relationships
• Flexibility/Working through Ambiguity: Energized by new experiences and perspectives
• Communicate: Managers share the company’s vision, strategies, and department goals
• Clarify: Managers define clear expectations and explain what good performance looks like
• Coach: Managers offer feedback and recognition, help solve challenges, and support employee performance
• Connect: Managers help teams understand their collective purpose
• Customize: Managers recognize individual team member uniqueness and adapt their support accordingly