Centivo

Auditor

• Perform auditing of claims, ensuring processing, payment, and financial accuracy by verifying all aspects of the claim have been handled correctly and according to both standard process and the client’s summary plan description.
• Completes reporting of audits finalized with decision methodology for procedural and monetary errors, which are used for quality reporting and trending analysis utilizing QA tools.
• Responsible to communicate corrections and adjustments to Examiners as identified on pre-payment audits, including high dollar claims, and to verify corrections and adjustments are complete and accurate.
• Identify and escalate trends based on the quality reviews.
• Confer with Claims QA Lead, Claims Supervisors, Claim Managers, and/or Training Lead on any problematic issues warranting immediate corrective action.
• May investigate and research issues as required to create or improve standard processing guidelines and may participate in projects as a subject matter expert as needed.
• Perform any other additional tasks as necessary, including processing of claims, creating policies, training, and/or mentoring examiners through quality improvement plans.

Claims Auditor

Human Resources

• Serve as the business partner for a subset of departments as well as the business partner for the leadership team in those same departments.
• Lead talent acquisition for your assigned departments and ensure our talent acquisition and onboarding processes lead to strong quality of hire and culture fit.
• Provide day to day people/human resources support and consultation across the business, supporting team members, managers and directors, particularly with performance management, coaching, engagement, growth and retention.
• Serve as an internal people team SME for an HR sub-specialty (eg leaves, performance, benefits, talent acquisition).
• Collaborate within the People team on projects and annual goals & priorities - executing some and leading on others.
• Help sustain and drive a culture of high engagement, inclusion and belonging where we all truly live and demonstrate our values.
• Support HR compliance requirements, ensuring we’re on top of all federal, state and local employment requirements.

HR Business Partner – HRBP

Product Analyst

• Monitor production systems and dashboards to identify issues, anomalies, or performance degradation.
• Investigate production incidents to determine scope, severity, and business impact.
• Partner with Support, Engineering, and Operations teams to troubleshoot issues and ensure quick resolution.
• Document findings and track recurring issues to prevent reoccurrence.
• Analyze system logs, data reports, and user feedback to identify potential defects or inconsistencies.
• Reproduce reported issues to validate defects and assist in root cause analysis.
• Maintain a defect backlog, prioritize based on business impact, and coordinate with development teams for resolution.
• Work closely with Product Managers to understand expected product behavior and validate production outcomes.
• Collaborate with QA teams to enhance test coverage based on production insights.
• Provide detailed, data-driven reports to stakeholders on incident trends, recurring defects, and system stability metrics.
• Recommend tools, processes, and automation opportunities to improve production reliability.
• Contribute to documentation and knowledge sharing around production issues and resolutions.

Data Analyst

• Collaborate with claims and stop loss operations teams to understand analytics and reporting needs that drive efficiency and scalability.
• Scope, gather, and structure requirements into actionable opportunities and solutions.
• Extract, manipulate, and analyze large datasets from claims databases using SQL or similar querying languages.
• Translate data into actionable insights and strategic recommendations that inform process improvements, resourcing decisions, and operational priorities.
• Develop models and algorithms to identify trends, anomalies, root causes of inefficiencies and areas for operational improvement.
• Design and maintain scalable dashboards and reports using tools like Tableau, Power BI, or similar platforms.
• Create and monitor productivity and performance metrics to assess and enhance departmental efficiency.
• Present findings to operations leadership with clear narratives that tie analytics to business outcomes.
• Serve as a technical liaison between claims operations and the core data team to ensure accuracy and quality in analytics.
• Develop and maintain SLA reporting to ensure claims operations meet and exceed client expectations.
• Proactively identify and recommend areas for automation, workflow enhancements, and optimization across the claims lifecycle.
• Ensure data integrity and accuracy across all analyses.

Senior Claims Data Analyst

Operations

• The Client Operations Specialist plays a vital role in supporting our Client Success team with the end-to-end delivery of health insurance services for employer groups, brokers, and individual members
• Act as Subject Matter Expert, representing the voice of the customer and client success, on any product, network, vendor discussions and rollouts
• Identify Client Success needs and requirements related to such rollouts, ensuring timely distribution of deliverables to Client Success
• Ensure accuracy and integrity of client data in internal systems
• Monitor KPIs related to client satisfaction, service level agreements (SLAs), and operational performance
• Alert Client Success if KPI’s are not meeting targets and make recommendations to improve performance

Client Operations Specialist

Customer Success Manager

• Own the client relationship. Serve as the strategic and day-to-day contact for your client portfolio, building deep, consultative partnerships with HR, Finance, and broker/consultant teams.
• Tell a compelling, data-driven story. Translate complex health, claims, and engagement data into meaningful insights that show progress, demonstrate value, and inspire confidence in Centivo’s approach.
• Drive client growth and retention. Lead renewals and strategic planning conversations that highlight measurable outcomes, promote member engagement, and identify opportunities to expand Centivo’s solutions across markets or populations.
• Guide a seamless client journey. Ensure a smooth transition from implementation to ongoing partnership, proactively anticipating client needs and aligning Centivo’s capabilities to meet them.
• Be the client’s voice inside Centivo. Collaborate cross-functionally with operations, analytics, and product teams to ensure we deliver with excellence and continuously enhance the client experience.
• Engage with brokers and consultants. Build trusted relationships that extend Centivo’s reach and strengthen our position as a high-value, innovative partner.
• Champion continuous improvement. Bring forward ideas and feedback that help evolve our client success playbook and enhance how we serve clients every day.

Client Success Executive

Business Analyst

• Triage operational issues, identify root cause and magnitude, recommend solutions
• Lead projects and tasks to completion to improve Claims team efficiency
• Use claims adjudication experience and TPA background to triage vendor and claims issues
• Coordinate with business units and external vendors during client implementations and conversions to determine requirements
• Ensure integration between internal and vendor systems to support client requirements and workflows
• Create process flows for new initiatives and existing processes
• Serve as liaison between business and technical resources
• Identify and articulate business requirements and facilitate brainstorming on solution options
• Assist and participate in claims testing for new technology, vendors, and processes
• Keep abreast of vendor enhancements and integration impacts
• Act as primary liaison with vendor for reported issues and enhancement requests
• Oversee claims platform upgrades and coordinate user acceptance testing
• Identify opportunities to increase automation, resolve system deficiencies, and enhance claims processing and reporting
• Participate in assessment of new technologies, vendors, and system enhancements
• Participate in plan design, strategy, and setup meetings
• Query data and create reporting to analyze issues, trends, and claim performance

Claims Business Analyst

Events

• Accept inbound calls from members and providers on inquiries pertaining to benefits, eligibility, and claims
• Research complex inquiries by use of tools, documentation, and outbound calls
• Educate members and providers on the benefits and navigation of Centivo site, tools, and applications
• Document all interactions and ensure proper processes/procedures are followed and follow-up action is taken
• De-escalate calls when necessary
• Address first-level complaints and provide assistance on appeals as needed;

Member/Provider Care Specialist

Customer Support

• Answer incoming calls from members and providers with questions about benefits, eligibility, and claims
• Research and resolve complex issues using company tools, documentation, and outbound calls
• Educate members and providers on how to navigate the platform, benefits, and resources
• Accurately document every interaction and follow established procedures
• Calmly de-escalate concerns and handle first-level complaints with empathy
• Support appeals processes and ensure timely follow-up actions are taken
• Participate in a team working to deliver affordable, high-quality healthcare solutions