Claims Supervisor - Management Ancillary Support (CMAS)

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 in Management Ancillary Services (CMAS). The Supervisor will be responsible for the oversight and management of the claim processing functions related to claims adjudication, appeals, escalations, quality, and recovery.

The CMAS Supervisor will have direct management of a team that supports, researches, and resolves the accurate processing of healthcare claims for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.

They will collaborate with internal and external partners to resolve issues and standardize processes, ensuring standard processes are established, policies are enforced, and issues are mitigated through collaborative decision-making.

Responsibilities Include:

• Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans

• Ensures that claims, appeals, and adjustments 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

• Liaison for the CMAS Team on various projects and/or initiatives including claims and testing needs to support system implementations and/or upgrades

• Performs other duties as deemed essential and necessary

Qualifications:

Required Skills and Abilities:

• 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.

Education and Experience:

• High School diploma or GED required. Bachelor’s degree or equivalent work experience.

• 5 years or more experience with healthcare claims administration, self-funded preferred.

• Experience leading and delegating tasks to multiple direct reports.

• Excellent verbal and written 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 from others.

• Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment.

• Proficient experience in MS Word, Excel, Outlook, and PowerPoint required.

• Candidates must have prior experience with a highly automated and integrated claim adjudication system; El Dorado-Javelina and/or Health Rules Payer experience preferred but not required.

Preferred Qualifications:

• Experience with member appeals, recovery processes, including NSA, subrogation and overpayment process, member, and/or client escalations.

• Ability to understand how, and to do thorough research, comfortable interviewing internal expertise and applying the 5 W’s and/or other tools to complete root cause analysis.

• Ability to assimilate quickly to the organization or department’s culture and speak in the voice of the brand; able to see the perspective of others and how to translate towards effective solutions.

• Ability to take complex issues and break them down so that it can be understood by others; ability to communicate with non-expert audiences.

• Strong knowledge of benefit plans, policies, and procedures, understanding of medical terminology.

• Strong technical and analytical skills.

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.

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 don’t 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.