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$70k–$77k/yr
Full-time
Equity, Bonus
Posted 46d ago
~40 hrs/week
Responsibilities
The Claims Supervisor leads a team of Claims Processors to ensure accurate and efficient processing of employer-sponsored health plans while maintaining productivity and quality standards. They are responsible for mentoring staff, managing claim inventories against SLAs, and collaborating with cross-functional teams to resolve system and process issues.
Requirements
Candidates must have at least 3 years of experience in a TPA environment with self-funded health plans and prior supervisory experience. Proficiency with highly automated claim adjudication systems, specifically HealthRules Payer, is required.
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.
Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.
The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.
Responsibilities Include:
Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations
Manages the inventory of claims against standard service level agreements (SLAs)
Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement
Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
Performs other duties as deemed essential and necessary
Qualifications:
Required Skills and Abilities:
Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.
Experience: Previous experience in claims processing or a related field, including supervisory experience.
Understands health insurance benefit administration in a Self-Funded environment
Ability to read and understand various forms, documentation, files, and information with the department.
Education and Experience:
Candidate must have at least 3 years of experience with self-funded health care plans and processing in a TPA environment
Candidate must have at least 3 years of experience supervising a claims team
Candidates must have prior experience with a highly automated and integrated claim adjudication system
Experience working with HealthRules Payer
Understanding of health insurance benefits administration in a self-funded environment
Preferred Qualifications:
Past Training Experience
Experience working at TPA
Experience with self-funded plans
Work Location:
An ideal candidate would be assigned to the Buffalo Office with ability to work from home.
If not in the Buffalo area, the opportunity can be remote.
Leadership Skills & Behaviors:
Strategic Thinking: Ability to sort through clutter to find the best route by identifying patterns in complexity, guiding future direction, narrowing options, and articulating choices for others to use.
Business Acumen: Quick understanding and handling of business situations, considering both risks and opportunities, with awareness extending beyond one's own function.
Systems/Analytical Thinking: Capacity to integrate information, anticipate non-linear and non-obvious relationships, and think holistically/conceptually, combined with tactical communication and clarification skills.
Flexibility/Working through Ambiguity: Energized by new experiences and perspectives, able to consider different viewpoints and incomplete information to develop effective and actionable next steps.
Communicate: Managers share the company’s vision, strategies, department goals, and provide necessary information to team members, especially during crises.
Clarify: Managers define clear expectations, explain what good performance looks like, address performance gaps, and ensure teams understand what is required.
Coach: Managers offer feedback and recognition, help solve challenges, reinforce positive culture, and support employee performance, growth, and career development.
Connect: Managers help teams understand their collective purpose and connect their work to the larger organization and its network.
Customize: Managers recognize individual team member uniqueness and adapt their support and management approach accordingly.
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
How many Healthcare jobs are open in Buffalo, NY right now?
There are currently 554 open healthcare positions in Buffalo, NY listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Buffalo, NY?
Companies currently hiring include Elderwood, Grider Support Services, LLC, UBMD Physicians' Group, DePaul, Dayforce, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Buffalo, NY?
Yes — 72 of the 554 open healthcare positions offer remote or hybrid work (28 remote, 44 hybrid).
How do I apply for Healthcare jobs in Buffalo, NY?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.