Director, Claims & Plan Docs (AI-Enabled Compliance)

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

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.