Job Overview
Location
Essen, Indiana, USA
Job Type
Full-time
Category
Operations Manager
Date Posted
February 27, 2026
Full Job Description
📋 Description
- • Centivo is on a mission to revolutionize healthcare by making it affordable and high-quality for the millions of workers and employers who form the backbone of our economy. We are seeking a highly motivated and experienced Manager, Claims – Management Ancillary Support (CMAS) to lead critical teams responsible for ensuring the accuracy, compliance, and efficiency of our claims processing operations. This pivotal role will oversee claims audit, appeals, escalations, recoveries, subrogation, NSA (Non-Standard Arrangements), and quality oversight, playing a crucial part in delivering on Centivo's promise of exceptional member and employer experiences.
- • As the CMAS Manager, you will be accountable for the operational results across all CMAS functions. This includes maintaining the highest standards of accuracy, ensuring strict adherence to compliance regulations, effectively managing claim inventory, and achieving established turnaround times. You will directly lead and mentor the CMAS team, fostering a high-performance culture while collaborating closely with cross-functional partners to resolve dependencies, standardize intricate processes, and continuously improve the execution of our claims workflows.
- • A core responsibility will be to ensure that all claims, appeals, and adjustments are processed with meticulous accuracy and in strict accordance with benefit plans, pricing agreements, authorizations, and all applicable regulatory requirements. You will be empowered to intervene proactively to resolve complex issues and manage critical escalations, ensuring that our members receive the benefits they are entitled to without undue burden.
- • You will be tasked with overseeing and managing the claim inventory against established Service Level Agreements (SLAs), strategically setting priorities for your team members to ensure optimal workflow and timely resolution. This involves a deep understanding of claim volumes, complexity, and resource allocation to meet and exceed performance targets.
- • Leading, coaching, and developing your staff is paramount. You will guide your team in the proper application of client benefit plans and ensure the achievement of both quality and production standards. This includes establishing and diligently monitoring performance plans for any team members who may be falling below expectations, providing constructive feedback and support for improvement.
- • Establishing clear accountability for training and onboarding outcomes is essential. You will ensure that skill development is not just a task, but a fundamental component of our core operations, equipping your team with the knowledge and expertise needed to navigate the complexities of healthcare claims.
- • You will lead the development and refinement of operational and quality Key Performance Indicators (KPIs) across all CMAS functions. A particular focus will be placed on day-to-day performance metrics, the timeliness of appeals processing, and ensuring robust regulatory compliance, providing data-driven insights to guide strategic decisions.
- • A key aspect of this role involves reviewing, analyzing, and reporting on operational performance. This includes detailed tracking of claim inventory, production volumes, turnaround lag times, and quality metrics. You will be responsible for communicating emerging trends, potential risks, and opportunities to department leadership, enabling informed strategic planning.
- • You will develop and execute comprehensive work plans designed to significantly reduce claim inventory and enhance overall service performance. This includes diligent oversight of overtime usage to ensure cost-effectiveness without compromising quality or timeliness.
- • Identifying and driving process improvement opportunities is a critical function. You will champion initiatives such as workflow standardization, the implementation of automation solutions, and the exploration of AI-enabled enhancements to further boost efficiency, elevate quality, and reduce turnaround times across the CMAS department.
- • You will oversee the development and rigorous enforcement of policies and procedures to guarantee that claim standards are administered with unwavering consistency. This involves actively monitoring team compliance and promptly addressing any identified gaps or deviations.
- • Setting clear team goals that are tightly aligned with departmental and organizational priorities is essential. You will provide ongoing feedback and conduct formal performance evaluations to support the individual growth, professional development, and accountability of each team member.
- • Maintaining accountability for team morale and engagement is a key leadership responsibility. You will foster a collaborative environment by actively involving staff in problem-solving initiatives and the design of practical solutions, creating a sense of shared ownership and purpose.
- • You will serve as the primary CMAS liaison on various projects and strategic initiatives. This includes participating in claims testing, providing essential support for system implementations or upgrades, and ensuring that CMAS considerations are integrated seamlessly into broader organizational efforts.
- • Partnering cross-functionally is vital to support client issue resolution and implementation efforts. You will ensure that CMAS-specific considerations are thoroughly incorporated into broader claims workflows, promoting a holistic approach to claims management.
- • You will act as a key point of contact, as needed, for clients, vendors, or providers who require dedicated CMAS relationship ownership, ensuring clear communication and effective partnership.
- • Finally, you will perform other duties as deemed essential and necessary to support the ongoing success and mission of Centivo.
🎯 Requirements
- • Bachelor’s degree or equivalent work experience required.
- • 5+ years of experience in healthcare claims administration; self-funded and/or TPA experience strongly preferred.
- • Demonstrated experience managing teams involved in claims audit, appeals, recovery, quality, or escalations.
- • Strong understanding of benefit administration, claims adjudication, and regulatory requirements.
- • Experience managing operational metrics, quality programs, and service levels in a regulated environment.
- • Prior experience with highly automated and integrated claims adjudication systems (e.g., Javelina, Health Rules Payer, or similar).
- • Strong communication, organizational, analytical, and problem-solving skills.
- • Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
🏖️ Benefits
- • Competitive salary and benefits package.
- • Opportunity to make a significant impact in a mission-driven organization focused on affordable, high-quality healthcare.
- • Collaborative and innovative work environment.
- • Professional development and growth opportunities.
- • Hybrid work model with a strong preference for local candidates in the WNY area, offering flexibility.
- • Comprehensive health, dental, and vision insurance.
- • Paid time off and holidays.
- • 401(k) plan with company match.
Skills & Technologies
Remote
Degree Required
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.
