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We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
Summary of role:
We are seeking a detail-oriented Claims Process & Training Specialist to design, document, test, and train claims workflows across the organization. This role is responsible for building clear, usable claims process documentation, developing training resources, and ensuring claims processes function as designed within core systems. The ideal candidate is highly organized, process-driven, and comfortable training as well as partnering cross-functionally to support operational excellence within the claims function.
Responsibilities Include:
Develop, document, and maintain end-to-end claims business processes and workflows, ensuring clarity, accuracy, and usability for claims team members.
Test claims workflows in Javelina and HRP to confirm processes function as designed and align with system configuration.
Document all new claims processes step-by-step in Confluence for use by claims team members when adjudicating claims.
Ensure documentation follows instructional design principles, is written in execution order, and includes screenshots as appropriate.
·Own and manage all existing claims process documentation in Confluence, (in addition to including creating new documentation) including editing existing content, archiving outdated materials, deleting obsolete content, etc.
·Build and maintain an intuitive documentation structure and search taxonomy to ensure ease of use and accessibility.
Create training and reference materials for the Claims organization, including Processors, Auditors, Recovery Analysts (including NSA and Subrogation), Appeals ·
Design and deliver specialty claims training as needed to support new processes, system changes, or operational initiatives.
As needed, support training and onboarding of Claims new hires
·Partner with POP, Core Platform, and PMO teams to ensure claims process documentation aligns with new hire training, system configuration, and operational standards.
Partner with POP as a subject matter expert to ensure claims process and adjudication content is accurate, providing quality review of new hire and enhanced training materials (including COB, adjustments, and corrected claims) and advising on the appropriate sequencing of content within new hire training.
As needed, support claims operations by processing claims to assist with workload coverage and inventory management.
Qualifications:
Required Skills and Abilities:
Excellent written and verbal communication skills, with the ability to serve as a subject matter expert and partner effectively across cross-functional teams.
Highly organized with strong attention to detail, including experience managing and maintaining documentation repositories and training resources.
Strong understanding of instructional design principles and the ability to translate complex payer/TPA claims processes into easy-to-follow documentation and learning tools.
Strong interpersonal skills, establishing rapport and working well with others
Education and Experience:
3 years’ experience working in Claims healthcare within a payer and/or TPA environment, with a strong understanding of medical claims processing and adjudication.
3 years demonstrated experience writing clear, detailed process documentation and/or developing training materials for operational teams.
Experience testing workflows or processes within claims systems to ensure accuracy, functionality, and usability.
3 years' experience conducting instructor-led and/or virtual training sessions, including onboarding and specialty training, for claims or healthcare operations teams.
Experience working within claims platforms such as Javelina and HRP, including navigating, testing, or supporting claims workflows.
Experience using HRP for claims processing is highly preferred
Work Location:
An ideal candidate would be assigned to the Buffalo Office with ability to work from home
Centivo Values:
● Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up.
● Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon.
Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a so
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
