Remote Senior Claims Manager - Self-Funded Health Plans

Centivo; Oregon; Hybrid; USD 110,000 - 140,000; Full time

Job summary

Centivo is seeking a Claims Manager to lead oversight of self-funded employer groups' health claims processing. You will directly manage claim supervisors, SMEs, and analysts, setting productivity goals and quality metrics while coordinating with cross-functional teams to reduce backlog and improve turnaround times.

You will mentor staff, report on inventory and SLA adherence, and contribute to policy development and system improvements.

Qualifications

• 5+ years in self-funded health care plans, with TPA environment experience.
• Experience with automated/ integrated claim adjudication systems; El Dorado-Javelina preferred.
• Strong leadership and ability to drive process improvements.
• Proficient in MS Office suite; Salesforce experience a plus.

Responsibilities

• Oversee health claims processing for self-funded employer groups and manage claim supervisors/SMEs.
• Set and monitor productivity goals and claim quality metrics across teams.
• Collaborate with Quality/Training and System Configuration to standardize processes and policies.
• Provide reporting on claim inventory, production, backlog, and turnaround time.
• Mentor staff, develop performance plans, and drive cost-effective overtime management.
• Liaise with clients/vendors/providers for issue resolution and escalation as needed.
• Support system implementations/testing and vendor/network partner management.

Skills

MS Word

Excel

Outlook

PowerPoint

Salesforce

Benefit administration

Leadership

Process improvement

Change management

Communication

Interpersonal skills

Education

5+ years self-funded health care/TPA experience

El Dorado-Javelina experience (preferred)

Advanced Excel (preferred)

Tools

El Dorado-Javelina

Health Rules (preferred)

Job description

Centivo is seeking a Claims Manager to lead oversight of self-funded employer groups' health claims processing. You will directly manage claim supervisors, SMEs, and analysts, setting productivity goals and quality metrics while coordinating with cross-functional teams to reduce backlog and improve turnaround times.

You will mentor staff, report on inventory and SLA adherence, and contribute to policy development and system improvements.