Director Claims Management Ancillary Services (CMAS)

Remotedxb; Dubai; On-site; AED 300,000 - 500,000; Full time

Job summary

Centivo is seeking a senior leader to own strategy, quality, and regulatory compliance for plan document functions (SPDs, SMMs, SBCs). You will ensure adherence to ERISA, HIPAA, COBRA, ACA and NSA, while overseeing claims activities and driving data-driven KPI monitoring.

Collaborate across Legal, Compliance, and Client Success to translate plan changes into precise documentation, and lead AI-enabled improvements.

Qualifications

• 7+ years in employee benefits compliance or healthcare claims operations.
• 5+ years' leadership experience managing managers or supervisors.
• Deep knowledge of ERISA, HIPAA, COBRA, and ACA as they apply to employer-sponsored plans.
• Experience drafting plan documents (SPDs, SMMs, SBCs) in self-funded or TPA environments.

Responsibilities

• Own the strategy, quality, and regulatory compliance of plan document functions (SPDs, SMMs, SBCs).
• Ensure compliance with ERISA, HIPAA, COBRA, ACA, and NSA requirements.
• Oversee claims audit, appeals, recoveries, subrogation, and NSA functions.
• Establish operational KPIs and monitor performance using data.
• Lead the Plan Documents Manager and CMAS Manager with coaching and feedback.
• Collaborate with Legal, Compliance, and Client Success to translate plan changes into accurate docs.
• Drive process improvement, workflow standardization, and AI-enabled enhancements.

Skills

Regulatory compliance

Leadership & people management

Plan documents management

ERISA knowledge

Data-driven KPI tracking

Cross-functional collaboration

Process improvement

AI enhancements

Education

Bachelor's degree

Tools

Phia Group PDM portal

Javelina

Health Rules Payer

Job description

Responsibilities

• Own the strategy, quality, and regulatory compliance of plan document functions, including SPDs, SMMs, and SBCs
• Ensure compliance with ERISA, Internal Revenue Code, HIPAA, MSP, COBRA, ACA, and WHCRA
• Oversee claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA) functions
• Establish operational and quality KPIs and monitor performance using data
• Manage the Plan Documents Manager and CMAS Manager, providing coaching and performance feedback
• Partner with Legal, Compliance, and Client Success to translate plan changes into accurate documentation
• Drive process improvement, workflow standardization, and AI-enabled enhancements

Requirements

• 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations
• 5 years of leadership experience managing managers or supervisors
• Deep knowledge of ERISA, HIPAA, COBRA, and the ACA as they apply to employer-sponsored benefit plans
• Experience overseeing plan document drafting (SBCs, SPDs, SMMs) in a self-funded or TPA environment
• Bachelor's degree required

Preferred Qualifications

• Employee benefits paralegal background
• Experience with Phia Group's PDM portal or similar management systems
• Experience with claims adjudication systems like Javelina or Health Rules Payer
• Experience leading claims system implementations

About the Company

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to millions. Centivo saves employers 15 to 30 percent compared to traditional insurance carriers through a primary care based ACO model.