Remote Claims Operations Lead – Self-Funded Health Plans

Centivo; Buffalo (NY); On-site; USD 70,000 - 77,000; Full time

Job summary

Centivo seeks a Claims Supervisor to lead a team of claims processors, driving accurate, efficient processing for employer-sponsored health plans. You will set productivity benchmarks, enforce quality standards, and partner with Quality/Training and System Configuration teams to standardize processes.

This role may oversee appeals, subrogation, and overpayments, ensuring compliance and timely resolutions. Office in Buffalo with potential remote work flexibility.

Qualifications

• 3+ years of experience with self-funded health care plans.
• 3+ years supervising a claims team.
• Experience with a highly automated adjudication system.
• Experience working with HealthRules Payer.
• Understanding of health insurance benefits administration in a self-funded environment.

Responsibilities

• Lead a team of claims processors to ensure accurate processing.
• Set productivity benchmarks and maintain quality standards.
• Manage backlog and reduce turnaround times.
• Collaborate with Quality/Training and System Configuration teams.
• Oversee appeals, subrogation, and overpayments/refunds when applicable.
• Provide reports on claim inventory and performance metrics.

Skills

Leadership

Analytical thinking

Claims processing

Self-funded health plans

Mentoring

Regulatory compliance

Tools

HealthRules Payer

Automated adjudication system

Job description

Centivo seeks a Claims Supervisor to lead a team of claims processors, driving accurate, efficient processing for employer-sponsored health plans. You will set productivity benchmarks, enforce quality standards, and partner with Quality/Training and System Configuration teams to standardize processes.

This role may oversee appeals, subrogation, and overpayments, ensuring compliance and timely resolutions. Office in Buffalo with potential remote work flexibility.