Claims Business Analyst at CENTIVO

Buffalo, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Dec, 25

Salary

0.0

Posted On

19 Sep, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Adjudication, Data Analysis, Problem-Solving, Project Management, Process Flows, SQL, Tableau, JIRA, Microsoft Office, Communication, Interpersonal Skills, Vendor Management, Automation, Health Insurance, Self-Funded Plans, Technical Liaison

Industry

Insurance

Description

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: As a Claims Business Analyst, you will be responsible for triaging operational issues and leading projects and tasks to completion. You will use your claims adjudication experience and TPA background to triage operational concerns, vendor issues, and related claims issues. Familiarity with Centivo’s claims systems (Javelina and HealthRules Payer) is preferred. You will coordinate with all business units and external vendors during client implementations and conversions to determine requirements. This role ensures seamless integration between internal and vendor systems to support client requirements and operational workflows. Additionally, you will lead key projects and tasks identified to improve efficiency of Centivo’s Claim team. This role will use data analytics and other tools to identify areas of improvement needed in the business, scope out the initiative, and then lead the project through to completion. Responsibilities Include: Support the Centivo Claims Team with troubleshooting issues, identifying the root cause and magnitude, and then researching and recommending the best solution. Effectively work with end-users and operational partners to identify business needs and to ensure implementations meet business requirements and appropriately address prioritized needs. Assist with creating Process Flows on new initiatives and existing processes as needed. Function as a liaison between business and technical resources to ensure people, processes, and solutions meet or exceed the needs of our Clients and Operational areas. Work with business partners to identify and articulate business requirements in each area. Facilitate brainstorming sessions to review solution options that will solve business needs. Assist and participate in the claims testing process for new technology, vendor, and processes. Proactively keep abreast of vendor enhancements as well as how they integrate with existing solutions. Collaborate with the Subject Matter Expert (SME) on all aspects of the functionality of the Claims systems and act as the primary liaison with the vendor for reported issues and enhancement requests. Work with the team on oversight of the implementation of claims platform upgrades and supporting technologies. This includes coordinating user acceptance testing with the operational leads. Proactively identify opportunities and recommend system solutions that increase automation, resolve system deficiencies, and enhance claims processing and reporting to meet and exceed business requirements. Participate in the assessment of new technologies, new vendors, and any system enhancements being contemplated. Participate in internal and external meetings for plan design, strategy, and setup. Query data or create reporting to support analysis of issues, trends or specific reporting needs for clients or providers related to claim performance. Required Skills and Abilities: Advanced problem-solving skills demonstrated by researching and resolving operational issues in a timely and accurate manner. Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions. Demonstrated ability to work in a fast-paced environment managing multiple issues with the pressure of production schedules and deadlines. Demonstrated ability to work collaboratively and influence others to drive results across multiple cross-functional teams. Proficiency in Microsoft Office applications and other web-based software applications. Demonstrated ability in running queries and performing data analysis to identify trends and issues. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others, including but not limited to reimbursement policy standards. Strong interpersonal skills, establishing rapport and working well with others Education and Experience: Candidates must have at least 5 years of experience within healthcare claims Candidates must have 3 years of experience working as a Business Analyst Candidates must have prior experience with a highly automated and integrated claim adjudication systems Understanding of health insurance benefits administration in a self-funded environment Preferred Qualifications: Experience working with El Dorado-Javelina or HealthRules Payer Experience working at TPA Experience with self-funded plans Proficient in SQL, Tableau and JIRA Intermediate to advanced proficiency in MS Excel Work Location: Preference for Buffalo Office Open to Remote 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 source of new energy. We celebrate together. We are supportive, generous, humble, and positive. 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.

Responsibilities

The Claims Business Analyst will triage operational issues and lead projects to completion, ensuring seamless integration between internal and vendor systems. This role involves using data analytics to identify areas for improvement and leading initiatives to enhance the efficiency of the Claims team.