{"id":3487836,"url":"https://alion.io/job/centivo-claims-manager","title":"Claims Manager","company":{"id":5923,"name":"Centivo","domain":"centivo.com","url":"https://alion.io/company/centivo","size_band":"201-500","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Ashby","truth_index":null},"role":"Finance","role_family":"Finance","seniority":"senior","employment_type":"full_time","work_mode":"hybrid","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Buffalo, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":95000,"max":100000,"currency":"USD","period":"year","gross":null,"usd_annual":100000},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-10-29T20:24:33Z","employer_posted_date":"2026-10-29","last_verified_at":"2026-11-02T05:28:29Z","board_verified":true,"closed_at":null,"days_open":3,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":3},"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.\nSummary of role:\nAs a Claims Manager, you will be responsible for the oversight and management of health claims processing for our self-funded employer groups. You will have direct management of claim supervisors, subject matter experts (SME), Claims Analysts who are responsible for the accurate processing and ancillary support of health care claims on behalf of the employer plan and members benefits and will set and monitor productivity goals and claim quality metrics. You will work across functional teams within Centivo to manage and resolve dependencies impacting backlog and turnaround time goals and with Quality/Training and System Configuration teams to ensure standard processes are established, policies are enforced, and issues are mitigated through collaborative decision making.\nResponsibilities Include:\nWorking under guidance of the Director- Claims Management, you will:\nDemonstrate knowledge and understanding of benefit administration for self-funded healthcare plans\n\nDirectly support the client relationship and implementation process by being a collaborative partner with teams responsible for client facing issue resolution\n\nMay be a direct point of contact for clients, vendors or providers that require relationship owners\n\nEnsure that metrics are established and monitored to ensure claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations\n\nManage the inventory of claims against standard service level agreements (SLA’s)\n\nEducate and mentors claims staff and 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\n\nProvides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics\n\nCreate work plans to reduce claim inventory, including management of over-time hours that are appropriately monitored for cost effectiveness\n\nDevelop 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\n\nAccountable 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\n\nResponsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance\n\nA liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades\n\nMay also have direct ownership and responsibility for vendor and network partners, invoice management for vendors, overpayment and recovery process, subrogation and appeals management, external pricing strategies, and continual process improvement initiatives\n\nPerforms other duties as deemed essential and necessary.\n\nQualifications:\nRequired Skills and Abilities:\nProficient experience in MS Word, Excel, Outlook, and PowerPoint required\n\nSalesforce experience is a plus, high efficiency with tool is a bonus\n\nUnderstanding of health insurance benefit administration in a Self-Funded environment\n\nStrong leadership and team management skills, with the ability to communicate effectively with others\n\nDemonstrate abilities with process development and improvement as well as change management\n\nAbility to read and understand various forms, documentation, files, and information with the department\n\nExcellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards\n\nStrong interpersonal skills, establishing rapport and working well with others\n\nExperience:\nAt least 5 years of experience with self-funded health care plans, and experience in a Third Party Administrator (TPA) environment\n\nMust have prior experience with a highly automated and integrated claim adjudication system, El Dorado-Javelina preferred but not required.\n\nPreferred Qualifications:\nExperience Health Rules Payer and/or El Dorado-Javelina\n\nAdvanced proficiency in Excel\n\nExperience managing Claims inventory\n\nWork Location:\nAn ideal candidate would be assigned to the Buffalo Office with ability to work from home\n\nRemote available for a strong fit\n\nCentivo Values:\nResilient - 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.\n\nUncommon - 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.\n\nPositive - 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.\n\nWho we are:\nCentivo 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.\nHeadquartered 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.","description_format":"text","description_chars":6677,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["Health insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Care Coordination & Population Health","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-29T22:15:50Z"}],"visa":[{"country":"US","licensed_sponsor":true,"evidence":"H-1B filings in 12 months: 2 · green card filings: 1","filings_12m":2,"filings_prev_12m":1,"green_card_filings_12m":1,"median_offered_wage_usd":159167,"route":null,"cap_exempt":false,"checked_at":"2026-10-29T16:27:21+00:00","sources":["US Department of Labor: LCA disclosure data (H-1B, H-1B1, E-3)","US Department of Labor: PERM disclosure data (green cards)"],"filings_for_role_12m":0}],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":2,"expected_fill_days":51,"reasons":["conf:0","win:early"],"computed_at":"2026-11-01T06:10:25Z"},"pay":{"stated_usd_annual":100000,"is_top_pay":false},"html_url":"https://alion.io/job/centivo-claims-manager","json_url":"https://alion.io/job/centivo-claims-manager.json","meta":{"generated_at":"2026-11-02T06:01:46Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":8644,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-03T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":5923},"rest":"https://alion.io/mcp/rest/get_company?id=5923"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fcentivo-claims-manager"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fcentivo-claims-manager"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fcentivo-claims-manager"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/centivo-claims-manager\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcentivo-claims-manager"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":3487836}},{"tool":"search_jobs","arguments":{"company":"centivo.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":3487836},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. 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