Job Overview
Location
Buffalo
Job Type
Full-time
Category
HR & Recruiting
Date Posted
July 10, 2026
Full Job Description
📋 Description
- • Perform auditing of claims (for internal and external constituents), 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 Claims Adjustors 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 Claims Adjustors through quality improvement plans.
🎯 Requirements
- • Prior experience with a highly automated and integrated claims processing system, El Dorado-Javelina or Health Rules Payer (HRP) preferred.
- • Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines.
- • Strong analytical, organizational, and interpersonal skills, with the ability to communicate effectively with others.
- • Attention to details, organized, quality and productivity driven.
🏖️ Benefits
- • Competitive salary
- • Comprehensive benefits package
- • Opportunities for professional growth and development
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Centivo Inc.
Centivo is a health plan administrator that partners with self-insured employers to provide affordable healthcare benefits. It builds custom networks of high-value primary care providers and specialists, emphasizing coordinated care, transparent pricing, and payment innovations like prospective bundled payments. The platform offers members digital tools for provider search, cost estimates, and care navigation, while giving employers predictable costs and data analytics to improve population health outcomes.
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