Claims Supervisor

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

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 over payment/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 (SLA's)
• Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing 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, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
• Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
• Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
• Performs other duties as deemed essential and necessary

• Knowledge:
  Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
• Leadership:
  Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
• Analytical
  
  Skills:
  
  Ability to analyze claims data and make informed decisions based on findings.
• Experience:
  
  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.

• Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment
• Candidate must have at least 3 years of experience supervising a claims team
• Candidates must have prior experience with a highly automated and integrated claim adjudication system
• Experience working with Health Rules Payer
• Understanding of health insurance benefits administration in a self-funded environment

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

• 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.

• Strategic Thinking
  - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward.
• Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner…