Director Claims Management Ancillary Services (CMAS)
Buffalo, New York, United States · Remote Solely
$135k–$145k/yr
Senior$226M raised
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Skills: Claims management, Plan document administration, Regulatory compliance, ERISA, HIPAA
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$135k–$145k/yr
Full-time
bachelor degree, professional certificate
Health benefits, Paid time off, Equity options, Bonus
Posted 18d ago
~40 hrs/week
Remote in United States
Responsibilities
The Director of Claims Management Ancillary Services oversees the strategy, performance, and regulatory compliance of claims ancillary functions and plan document administration. This role manages key teams, establishes operational KPIs, and serves as the primary authority for clients and partners regarding claims and plan document standards.
Requirements
Candidates must have at least 7 years of experience in employee benefits compliance or healthcare claims operations and 5 years of leadership experience. A bachelor's degree is required, along with deep knowledge of ERISA, HIPAA, and other relevant healthcare regulations.
Full job description
We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
Summary of role:
The Director, Claims Management Ancillary Services (CMAS) owns the strategy, performance, and compliance of Centivo's claims ancillary functions, with particular emphasis on the Plan Documents function. This role directly manages the Plan Documents Manager and the CMAS Manager and is accountable for the accuracy, timeliness, and regulatory compliance of Centivo's plan documents -- including SBCs, SPDs, SMMs, and amendments -- as well as the performance of claims audit, appeals, escalations, recoveries, subrogation, and NSA functions.
The Director translates departmental and organizational strategy into executable plans, builds a high-performing and accountable team, and serves as the operational authority for CMAS and Plan Documents with clients, brokers, agents, TPAs, and stop loss carriers.
Responsibilities Include:
Plan Documents Strategy & Compliance
Own the strategy, quality, and regulatory compliance of Centivo's plan document function, including Summary Plan Descriptions (SPDs), Summary of Material Modifications (SMMs), plan amendments, and Summary of Benefits and Coverage (SBCs)
Ensure plan document processes and content remain current with the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code, HIPAA, the Medicare Secondary Payer Act (MSP), COBRA, the Affordable Care Act (ACA), and the Women's Health and Cancer Rights Act (WHCRA)
Establish document governance standards, review workflows, and quality checkpoints to ensure plan documents are accurate, complete, and audit-ready across all clients and plan types
Partner with Legal, Compliance, Configuration, and Client Success to translate client implementations, plan changes, and regulatory updates into accurate plan document output
Serve as the escalation point for complex plan document issues, client-specific plan design questions, and stop loss carrier document submissions
Champion adoption and continuous improvement of plan document tools and technology (e.g., PDM) to improve accuracy, throughput, and client experience
CMAS Operational Leadership
Own end-to-end performance of CMAS functions—claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA)—ensuring accuracy, compliance, and adherence to service-level agreements
Establish and monitor operational and quality KPIs across CMAS and Plan Documents, using data to identify trends and risks and to report performance to department leadership
Direct workforce and capacity planning across both functions, including inventory management, resource allocation, and overtime oversight, to balance cost efficiency with service performance
Drive process improvement, workflow standardization, and automation and AI-enabled enhancements across CMAS and Plan Document workflows
Oversee development and enforcement of policies and procedures to ensure consistent administration of CMAS and Plan Document standards
People Leadership & Cross-Functional Collaboration
Directly manage the Plan Documents Manager and CMAS Manager, providing coaching, performance feedback, and development aligned to Centivo's leadership behaviors
Set clear performance expectations and measurable goals for both teams, aligned to organizational priorities, and hold managers accountable for results
Foster a culture of accountability, collaboration, and engagement across the CMAS and Plan Documents teams, involving staff in problem-solving and solution design
Represent CMAS and Plan Documents in cross-functional meetings, client calls, and discussions with brokers, agents, TPAs, and stop loss carriers, serving as the operational authority for these functions
Model and reinforce Centivo's leadership behaviors — Communicate, Clarify, Coach, Connect, and Customize — through daily interactions and team management practices
Perform other duties as deemed essential and necessary
Qualifications:
Required Skills and Abilities:
7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations at a TPA, health plan, or benefits consulting firm
5 years of leadership experience managing managers, supervisors, or teams, including experience overseeing plan document, compliance, or claims ancillary functions
Deep knowledge of ERISA, the Internal Revenue Code, HIPAA, MSP, COBRA, the ACA, and WHCRA as they apply to employer-sponsored welfare benefit plans
Demonstrated experience overseeing plan document drafting and management (SBCs, SPDs, SMMs) in a self-funded or TPA environment
Demonstrated experience overseeing claims audit, appeals, recoveries, subrogation, NSA, or quality assurance functions in a regulated environment
Strong data literacy; ability to interpret operational and quality metrics and translate findings into action plans
Experience partnering with Legal, Compliance, Configuration, and Client Success teams to resolve cross-functional dependencies
Bachelor's degree required; paralegal certification or advanced degree in a relevant discipline preferred
Preferred Qualifications:
Employee benefits paralegal background or equivalent experience in plan document creation and management
Experience with Phia Group's PDM portal or similar plan document management systems
Experience with claims adjudication systems (e.g., Javelina, Health Rules Payer, or similar)
Experience leading or contributing to a claims system implementation or transformation
Experience in client-facing roles or working closely with account management teams on claims or plan document issues
Work Location:
This position is remote.
Centivo Values:
Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.
Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
A new kind of healthcare company committed to restoring affordability for American workers and their employers
Industry
Insurance
Company size
201-500 employees
Founded
2017
Headquarters
Buffalo, New York
LinkedIn followers
12,160
Total funding
$226M
Centivo is a new kind of healthcare company committed to restoring healthcare affordability for American employers and their people.
Founded in 2017, Centivo’s model was designed specifically to curb the inefficiency and waste in today’s employer healthcare market. In partnership with leading local health systems, Centivo’s primary care-centered health plan offers U.S. employers a replacement to traditional health insurance carriers, lowering the total cost of care by 30% or more while delivering tangible value to employers, employees, and its partner health systems.
Centivo delivers on its mission every day for its diverse employer clients across America – from local bakeries and schools to Fortune 100 enterprises.
Important hiring disclaimer
We will never ask you to pay an application fee to work with us, nor do we work with any recruiters who would. Please be cautious of anyone claiming to represent Centivo who requests payment to be considered for a role. We also do not extend offer letters via social media platforms. All official offers come from our @centivo.com email domain, through Ashby, which is our application tracking system. Additionally, we will never ask for personal information for a background check until after you’ve accepted a formal offer, and we do not issue checks with offer letters or before your first day of employment. Our careers page (https://centivo.com/careers) always has the latest on open positions. Please apply to roles directly through this page.
Offices: 77 Goodell St, 5th floor, Buffalo, New York 14203, US · 205 E 42nd St, New York, NY 10017, US
health benefitshealth insurancevalue-based carehealthcarehealthcare provider networksaffordable healthcareself-funded health plansemployer-sponsored health plansvirtual primary carelevel funding
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