Claims Supervisor

Centivo•Buffalo, NY

7d•$70,000 - $77,000•Remote

About The Position

Centivo is seeking a Claims Supervisor to lead a team of Claims Processors and ensure accurate, efficient claims processing for employer-sponsored health plans. The role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. The supervisor works with support teams to manage claim backlogs and turnaround times, and collaborates with Quality/Training and System Configuration teams to standardize processes and resolve issues. The role may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency. The ideal candidate has a thorough understanding of self-funded health plan benefit administration, claims handling, and related legal requirements, together with claims-processing and supervisory experience. The position is ideally assigned to Centivo’s Buffalo office with the ability to work from home; candidates outside the Buffalo area may work remotely.

Requirements

At least 3 years of experience with self-funded healthcare plans and claims processing in a TPA environment.
At least 3 years of experience supervising a claims team.
Prior experience with a highly automated and integrated claim adjudication system.
Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
Strong leadership and team management skills, including the ability to manage and motivate a team.
Ability to analyze claims data and make informed decisions based on findings.
Understanding of health insurance benefit administration in a self-funded environment.
Ability to read and understand forms, documentation, files, and other information used by the department.
Strategic thinking, business acumen, systems and analytical thinking, and flexibility in working through ambiguity.
Ability to communicate goals and expectations, clarify performance standards, coach and support employees, connect team work to organizational purpose, and adapt management to individual team members.

Nice To Haves

Experience working with HealthRules Payer.
Past training experience.
Experience working at a TPA.
Experience with self-funded plans.

Responsibilities

Apply knowledge of benefit administration for self-funded healthcare plans.
Ensure claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations.
Manage claim inventory against standard service level agreements (SLAs).
Educate and mentor claims staff so they apply client benefit plans correctly and meet quality and production metrics; establish performance plans and provide coaching and mentoring to improve performance when needed.
Provide department leaders with reports on claim inventory, production, turnaround lag, and quality metrics.
Develop policies and procedures for proper administration of benefit plans and claim standards; assist in developing operational policies and procedures and monitor staff compliance.
Influence department morale, set achievable goals, and foster teamwork by involving employees in designing and implementing solutions.
Establish annual staff goals aligned with organizational strategies and personal growth, and provide timely, constructive performance feedback.
Serve as a claims liaison for projects and initiatives, including testing for system implementations and upgrades.
Perform other duties deemed essential and necessary.
Work with support teams to manage backlog and turnaround times, and with Quality/Training and System Configuration teams to standardize processes and resolve issues.
May oversee appeals, subrogation, and overpayment/refunds.