Client Operations Specialist

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.

Summary of role :

The Client Operations Specialist plays a vital role in supporting our Client Success team with the end-to-end delivery of health insurance services for employer groups, brokers, and individual members. This position acts as a conduit between Client Success and the broader Centivo organization, helping to ensure that market facing needs and requirements are being accounted for in our day-to-day operations or broader projects that will impact the market facing team. The ultimate objective of the Client Ops team is to reduce the administrative & operational burden of our Client Success teams through standardization and process optimization.

Responsibilities Include :

Subject Matter Expertise :

Act as Subject Matter Expert, representing the voice of the customer and client success, on any product, network, vendor discussions and rollouts

Identify Client Success needs and requirements related to such rollouts, ensuring timely distribution of deliverables to Client Success

Support will be expected but not limited to Open Enrollment, Plan Renewals and any plan changes

Project management and system support for internal systems (Plan Manager, Portal) will be required of this role.

Data & Reporting :

Ensure accuracy and integrity of client data in internal systems.

Monitor KPIs related to client satisfaction, service level agreements (SLAs), and operational performance.

Alert Client Success if KPIs are not meeting targets and make recommendations to improve performance

Process Optimization & Workflow Management :

Identify inefficiencies in client-facing processes and propose solutions.

Develop and maintain standard operating procedures (SOPs).

Partner with all areas of the organization, including but not limited to : Client Success, Account Management, Product, and IT, to ensure consistent delivery of outputs.

Claims & Benefit Administration Support and Client Communication

Assist with any broad claims issues when necessary.

Identify issue impact and communicate root causes and resolution steps clearly to client success, while also working with Communications on external communication if / when necessary

Handle client inquires by collaborating with Claims and Member Care departments to resolve and / or escalate member issues, including VIP member issues with internal Customer Advocacy team

Provide timely updates on system changes, process impacts, or service issues / outages.

Escalation Prioritization and Monitoring :

Own the intake, tracking, and resolution of broad operational client issues (e.g., file failures, processing delays, network changes, etc).

Log, track, and resolve escalations by coordinating with internal departments like claims, IT, eligibility, etc.

Identify issue impact and communicate root causes and resolution steps clearly to client success.

Vendor Integrations :

Support Client Success with integration of third-party vendors for clients (e.g., PBM, eligibility vendors, point solutions, etc).

Facilitate internal process including requirement gathering, ticket submission and monitoring

Qualifications :

Required Skills and Abilities :

Experience working work with health insurance products (HMO, PPO, HDHP, etc.), funding types (fully insured, ASO, Level Funded), and regulations (ACA, HIPAA).

Strong organizational and project management skills.

Proficiency with MS Office (Excel, Outlook, Word);

Excellent written and verbal communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others

Holds high Customer Service standards and aims to be client-orientated with a drive for quality service

Education and Experience :

5 years of experience in health insurance, healthcare, or employee benefits, preferably in a client-facing or operational role

Must have worked in a TPA or direct carrier setting

Experience working in JIRA, SQL and Tableau

Preferred Qualifications :

Bachelor's Degree

Experience working with self-funded healthcare plans

Knowledge of claims administration, billing cycles, and eligibility system

Experience with CRMs and health plan administration systems

Work Location :

This position is remote

Occasional travel for client meetings or training may be required

Centivo Values : ?

Resilient This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we dont give up.?

Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon .?

Positive We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive . ?

Who we are :

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com .

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.