Claims Manager - Management Ancillary Support (CMAS)

Manages claims audit, appeals, escalations, recoveries, subrogation, NSA, and quality oversight.

• •Centivo is seeking a Manager, Claims
• •Management Ancillary Support (CMAS) to lead teams responsible for claims audit, appeals, escalations, recoveries, subrogation, NSA, and quality oversight.
• •Key Responsibilities Ensure claims, appeals, and adjustments are processed accurately and in accordance with benefit plans, pricing agreements, authorizations, and regulatory requirements.
• •Oversee and manage claim inventory against established service-level agreements (SLAs), setting priorities for team members.
• •Direct, coach, and develop staff, ensuring proper application of client benefit plans and achievement of quality and production standards.
• •Lead the development and refinement of operational and quality KPIs across CMAS functions.
• •Identify and drive process improvement opportunities, including workflow standardization, automation, and AI-enabled enhancements.
• •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.