Centivo Benefits Overview

Leads Centivo’s Claims Management Ancillary Services and Plan Documents functions, overseeing strategy, compliance, quality, performance, workforce planning, and process improvement. Ensures accurate and timely SPDs, SMMs, SBCs, amendments, claims audits, appeals, recoveries, subrogation, and No Surprises Act processes. Manages two functional leaders, develops team performance, monitors operational KPIs, partners cross-functionally, and serves as the operational authority for clients, brokers, TPAs, and stop-loss carriers.

Lead and coach a claims processing team for self-funded employer health plans, enforce SLAs and quality standards, manage claim inventory and backlog, develop policies and procedures, collaborate with Quality/Training and System teams, oversee appeals/subrogation/overpayments, and report performance metrics.

Prepare, finalize, and maintain complex employee benefit plan documents, including SBCs, SPDs, and SMMs. Verify eligibility and plan requirements, address compliance and customization inquiries, support client and vendor communications, manage assigned accounts and projects, and assist with training junior team members. The role requires expertise in self-funded health and welfare plans, ERISA and non-ERISA benefits, client management, and applicable federal mandates.