Claims Director

Centivo Inc.

Job Overview

Location

USA

Job Type

Full-time

Full Job Description

📋 Description

• The Claims Director at Centivo Inc. serves as the critical operational and strategic bridge between executive leadership and front-line claims management, owning the end-to-end performance of the claims operation to ensure affordable, high-quality healthcare delivery for self-funded employers and their employees.
• This role translates company strategy into executable plans while building a high-performing, accountable team focused on driving claims quality, speed, and scalability through disciplined inventory management, technology transformation, and client experience excellence.
• Day-to-day responsibilities include owning the operational performance of the claims department, overseeing Claims Managers, Supervisors, SMEs, and Sr. Examiners, and ensuring claims are processed within defined SLAs across all claim types and funding arrangements.
• The Director establishes, monitors, and enforces inventory management standards and workflows, creates and executes work plans to reduce and sustain optimal inventory levels, and uses data to set targets for payment accuracy and drive continuous improvement.
• They develop and own the claims department's client experience strategy, ensuring operational execution reflects Centivo's service commitments, and establish feedback loops with client-facing teams to translate findings into operational improvements.
• As the claims operational owner of the system transformation from Javelina to HRP, the Director partners with Technology, Implementation, and Product teams to ensure a successful transition with minimal disruption to SLAs, client commitments, and member experience.
• They partner with Quality and Training teams to design and maintain curricula ensuring consistent application of benefit plan knowledge, adjudication standards, and compliance requirements, and establish proficiency standards and competency checkpoints for all claims roles.
• The Director owns the prioritization of claims projects and client needs, balancing competing demands across operational improvement initiatives, system transformation workstreams, and time-sensitive client escalations, communicating decisions clearly to leadership and cross-functional partners.
• They represent the claims organization in cross-functional meetings, vendor discussions, client calls, and provider engagements, serving as the operational authority for claims-related topics and ensuring commitments are realistic, documented, and effectively handed off.
• Leading a structured root cause analysis (RCA) program, they identify, categorize, and resolve underlying drivers of claims errors, partnering with Quality, Configuration, and Product teams to close the loop on error trends and ensure fixes are implemented and sustained.
• The role drives continuous improvement in claims processing workflows by identifying manual touchpoints, redundant steps, and pend patterns that create friction and delay, redesigning processes to reduce waste and improve throughput.
• They identify opportunities for process automation, workflow optimization, and technology leverage to improve scale and reduce unit cost in claims operations, collaborating with Plan Configuration, Stop Loss, Quality, Provider Operations, and Member Operations teams.
• The Director translates VP-level operational strategy into department-level goals, plans, and priorities, cascading direction clearly to managers and holding teams accountable for execution.
• In people leadership, they directly manage Claims Managers, providing coaching, performance feedback, and development support aligned to Centivo's leadership behaviors, setting clear performance expectations, and establishing measurable goals aligned to organizational priorities.
• They model and reinforce Centivo's leadership skills — Communicate, Clarify, Coach, and Connect — through daily interactions, fostering a culture of accountability, execution rigor, and psychological safety within the claims department.
• The role requires 7 years of experience in healthcare claims operations at a third-party administrator and 5 years of leadership experience managing claims teams, including direct management of managers or supervisors.
• Deep knowledge of self-funded health plan administration, claims adjudication, and healthcare payer compliance requirements is essential, along with demonstrated experience owning claims inventory management and driving measurable improvement in turnaround time and auto-adjudication performance.
• Experience leading or contributing significantly to a claims system implementation or transformation (with Javelina and/or HRP experience a plus) is required, as is proven ability to develop and execute training strategies that drive quality and consistency across large claims teams.
• Strong data literacy, the ability to interpret operational metrics, identify trends, and translate findings into action plans, and experience in client-facing roles or working closely with account management teams on claims-related issues are required.
• Familiarity with continuous improvement methodologies and process management principles is expected, along with leadership competencies in business acumen, accountability & execution, charisma, empathy/humility, strategist mindset, systems thinking, process orientation, and flexibility/working through ambiguity.
• The Director must embody Centivo's People Manager Leadership Behaviors: Communicate, Clarify, Coach, Connect, and Customize, adapting their approach based on individual and task needs.
• Centivo's culture is defined by its values of being Resilient, Uncommon, and Positive — believing in building something better for members, employers, and providers while celebrating wins and supporting each other through challenges.
• The position offers remote work flexibility or the option to work onsite in the Buffalo office, reflecting Centivo's commitment to flexibility and work-life balance.
• As an innovative health plan for self-funded employers, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers and provides employees with free primary care (including virtual), predictable copays, and no-deductible benefit plans.
• Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including Morgan Health, a business unit of JPMorgan Chase & Co., underscoring its mission-driven growth and stability.

🎯 Requirements

• 7 years of experience in healthcare claims operations at a third-party administrator
• 5 years of leadership experience managing claims teams, including direct management of managers or supervisors
• Deep knowledge of self-funded health plan administration, claims adjudication, and healthcare payer compliance requirements
• Demonstrated experience owning claims inventory management and driving measurable improvement in turnaround time and auto-adjudication performance
• Experience leading or contributing significantly to a claims system implementation or transformation (experience with Javelina and/or HRP a plus)
• Proven ability to develop and execute training strategies that drive quality and consistency across large claims teams

🏖️ Benefits

• Remote work flexibility or option to work onsite in Buffalo office
• Opportunity to impact affordable, high-quality healthcare access for millions of workers and employers
• Backed by leading healthcare and technology investors, including Morgan Health (JPMorgan Chase & Co.)
• Part of a mission-driven organization saving employers 15-30% vs. traditional carriers and providing employees with free primary care and predictable copays
• Culture rooted in Resilient, Uncommon, and Positive values with emphasis on recognition, feedback, and team support
• Clear path to influence strategic direction and lead transformation initiatives in claims operations and technology

Skills & Technologies

Remote

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Centivo Inc.

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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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