Remote Claims Operations Leader

Centivo; Buffalo (AL); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Centivo in Buffalo, NY is seeking a Claims Manager to lead oversight of health claims processing for self-funded employer groups. You will manage claim supervisors, SMEs, and Analysts, set productivity goals, and monitor quality metrics while coordinating with cross-functional teams.

You will guide policy development, ensure SLA alignment, mentor staff, and deliver reports on claim inventory, turnaround times, and performance.

Qualifications

• 5+ years of experience with self-funded health care plans.
• Experience in a Third Party Administrator (TPA) environment.
• Experience with automated claim adjudication systems; El Dorado-Javelina preferred.
• Strong leadership and coaching abilities.
• Excellent written and verbal communication skills.
• Ability to manage vendor relationships and SLA compliance.

Responsibilities

• Demonstrate knowledge of benefit administration for self-funded plans.
• Support client relationships and implementation with issue resolution.
• May be a direct contact for clients, vendors, or providers.
• Ensure claims are processed and paid per benefit plans, pricing and authorizations.
• Manage inventory of claims against standard service level agreements (SLAs).
• Educate and mentor staff, set performance plans for those below expectations.
• Provide reports on claim inventory, production, turnaround lag, and quality metrics.
• Develop policies for operations and ensure staff compliance.
• Establish annual goals for staff aligned with organizational strategy.
• Collaborate on projects including testing for system implementations/upgrades.
• Oversee vendor and network partner relationships and related processes.
• Perform other duties as deemed essential.

Skills

Leadership and people management

Strong communication skills

Process development and improvement

Health insurance benefit admin knowhow

Relationship management

Analytical reporting

Tools

MS Word

Excel

Outlook

PowerPoint

Salesforce

El Dorado-Javelina

Job description

Centivo in Buffalo, NY is seeking a Claims Manager to lead oversight of health claims processing for self-funded employer groups. You will manage claim supervisors, SMEs, and Analysts, set productivity goals, and monitor quality metrics while coordinating with cross-functional teams.

You will guide policy development, ensure SLA alignment, mentor staff, and deliver reports on claim inventory, turnaround times, and performance.