Claims Manager

This is a fully remote position, open to applicants in New York.

📋 Description

• Supervise and oversee the processing of health claims for self-funded employer groups.

• Directly manage claim supervisors, subject matter experts, and Claims Analysts.

• Set and track productivity objectives and quality metrics for claims.

• Manage interdepartmental dependencies that impact backlog and turnaround-time targets.

• Collaborate with Quality/Training and System Configuration teams to develop standardized procedures and address issues.

• Support client relationships and the implementation process.

• Act as a contact point for clients, vendors, or providers as needed.

• Establish and track metrics for claims processing and payment in accordance with benefit plans, pricing agreements, and authorizations.

• Manage claims inventory in line with standard service level agreements.

• Educate and mentor claims personnel; create performance plans and provide coaching.

• Report on claim inventory, production, turnaround lag, and quality metrics to department leadership.

• Develop work plans to decrease claims inventory and monitor overtime for cost efficiency.

• Formulate and oversee policies and procedures for benefit plan and claims administration.

• Promote employee morale, teamwork, goal setting, and professional development.

• Set annual goals for staff and deliver timely, constructive performance feedback.

• Coordinate on claims-related projects, initiatives, testing, system implementations, and upgrades.

• Potentially manage vendors and network partners, vendor invoices, overpayments and recovery, subrogation, appeals, pricing strategies, and process enhancements.

• Perform other essential duties as required.

⛳️ Requirements

• Proficient in MS Word, Excel, Outlook, and PowerPoint.

• Knowledge of health insurance benefit administration within a self-funded context.

• Strong leadership abilities and team management skills.

• Effective communication skills with others.

• Proven experience in process development, improvement, and change management.

• Ability to read and comprehend various forms, documentation, files, and departmental information.

• Excellent verbal and written communication capabilities.

• Capacity to convey complex or technical information clearly and concisely.

• Strong interpersonal skills.

• Minimum of 5 years of experience with self-funded healthcare plans.

• Experience in a Third Party Administrator (TPA) setting.

• Prior experience with a highly automated and integrated claims adjudication system.

• Salesforce experience is advantageous.

• El Dorado-Javelina experience preferred but not mandatory.

• Experience with Health Rules Payer and/or El Dorado-Javelina is preferred.

• Advanced Excel proficiency is preferred.

• Experience in managing claims inventory is preferred.

• Must be authorized to work in the United States for any employer.

• Centivo does not sponsor work authorization visas.

🏝️ Benefits

• Equity option grants.

• Bonus opportunities.

• Health benefits, with some employer contributions.

• Paid time off (PTO).

• Flexibility to work from home for remote candidates.

• Free primary care (including virtual visits), with predictable copays and no-deductible benefit plan design for Centivo-covered employees.