Claims Manager – Management Ancillary Support
Centivo
full-time
Posted on:
Location Type: Hybrid
Location: Buffalo • New York • United States
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Salary
💰 $100,000 per year
About the role
- Ensure claims, appeals, and adjustments are processed accurately and in accordance with benefit plans, pricing agreements, authorizations, and regulatory requirements, intervening as needed to resolve issues and escalations.
- Oversee and manage claim inventory against established service-level agreements (SLAs), setting priorities for team members.
- Direct, coach, and develop staff, ensuring proper application of client benefit plans and achievement of quality and production standards; establish and monitor performance plans for team members falling below expectations.
- Establish clear accountability for training and onboarding outcomes, ensuring skill development is treated as essential to core operations.
- Lead the development and refinement of operational and quality KPIs across CMAS functions, with particular focus on day-to-day performance, appeals timeliness, and regulatory compliance.
- Review, analyze, and report on operational performance, including claim inventory, production volumes, turnaround lag, and quality metrics, and communicate trends and risks to department leadership.
- Develop and execute work plans to reduce claim inventory and improve service performance, including oversight of overtime usage to ensure cost effectiveness.
- Identify and drive process improvement opportunities, including workflow standardization, automation, and AI-enabled enhancements, to improve efficiency, quality, and turnaround times.
- Oversee the development and enforcement of policies and procedures to ensure claim standards are administered consistently; monitor team compliance and address gaps.
- Set team goals aligned with departmental and organizational priorities, providing ongoing feedback and formal performance evaluations to support individual growth and accountability.
- Maintain accountability for team morale and engagement, fostering collaboration by involving staff in problem-solving and solution design.
- Serve as the CMAS liaison on projects and initiatives, including claims testing and support for system implementations or upgrades.
- Partner cross-functionally to support client issue resolution and implementation efforts, ensuring CMAS considerations are incorporated into broader claims workflows.
- Act as a point of contact as needed for clients, vendors, or providers requiring CMAS relationship ownership.
- Perform other duties as deemed essential and necessary.
Requirements
- Bachelor’s degree or equivalent work experience required.
- 5+ years of experience in healthcare claims administration; self-funded and/or TPA experience strongly preferred.
- Demonstrated experience managing teams involved in claims audit, appeals, recovery, quality, or escalations.
- Strong understanding of benefit administration, claims adjudication, and regulatory requirements.
- Experience managing operational metrics, quality programs, and service levels in a regulated environment.
- Prior experience with highly automated and integrated claims adjudication systems (e.g., Javelina, Health Rules Payer, or similar).
- Strong communication, organizational, analytical, and problem-solving skills.
- Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
Benefits
- Offers Equity
- Offers Bonus
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims administrationclaims adjudicationregulatory complianceoperational metrics managementquality programsservice level agreementsprocess improvementworkflow standardizationautomationAI-enabled enhancements
Soft Skills
team managementcoachingperformance evaluationcommunicationorganizational skillsanalytical skillsproblem-solvingcollaborationaccountabilitymorale and engagement