Claims Supervisor

Claims Supervisor

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.

Responsibilities Include:

• 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

Qualifications:

Required Skills and Abilities:

• 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.

Education and Experience:

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 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 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 that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function.

Systems/Analytical Thinking Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually very powerful when accompanied by ability to communicate & clarify tactically.

Flexibility/Working through Ambiguity Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps.

Communicate Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know.

Clarify As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding.

Coach Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development.

Connect Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network.

Customize As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them.

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.