Remote Claims Operations Lead

Centivo; Oregon; Híbrido; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient processing for employer-sponsored health plans. The role drives productivity benchmarks, quality standards, and continuous improvement, collaborating with Quality/Training and System Configuration teams to standardize processes and resolve issues.

The ideal candidate will have hands-on leadership and a deep understanding of self-funded health plan administration, mentoring staff, and

Formación

• 3+ years of experience with self-funded health care plans in a TPA environment.
• 3+ years of experience supervising a claims team.
• 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.

Responsabilidades

• Lead a team of Claims Processors and set productivity benchmarks.
• Ensure claims are processed and paid per benefit plans and authorizations.
• Manage claim inventory against SLAs and tracking metrics.
• Mentor staff to meet quality and production targets with coaching.
• Provide reports on claim inventory, production, turnaround lag, and quality metrics.
• Develop policies to administer benefit plans and monitor compliance.
• Set annual staff goals aligned with organizational strategy and provide feedback.
• Serve as liaison for claims on projects and system upgrades.
• Perform other essential duties as needed.

Conocimientos

Leadership

Analytical thinking

Claims processing

Team mentoring

Self-funded health plans

Herramientas

HealthRules Payer

Descripción del empleo

Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient processing for employer-sponsored health plans. The role drives productivity benchmarks, quality standards, and continuous improvement, collaborating with Quality/Training and System Configuration teams to standardize processes and resolve issues.

The ideal candidate will have hands-on leadership and a deep understanding of self-funded health plan administration, mentoring staff, and