Director Claims Management Ancillary Services (CMAS)
CentivoEmployer Health company
RemoteDirector
Bain Capital Ventures
Bessemer Venture Partners
F-Prime Capital Partners
Maverick Ventures
Ingleside Investors
Rand Capital
Operations & StrategyNew
About the role
TL;DR
Leads strategy, performance, and compliance for claims ancillary functions and plan documents.
- •The Director, Claims Management Ancillary Services (CMAS) is responsible for the strategy, performance, and compliance of Centivo's ancillary claims functions, with a strong focus on the Plan Documents function.
- •This role oversees the accuracy, timeliness, and regulatory compliance of plan documents and the performance of claims audit, appeals, and recoveries.
- •Key Responsibilities Own the strategy, quality, and regulatory compliance of Centivo's plan document function (SPDs, SMMs, amendments, SBCs).
- •Ensure plan document processes align with ERISA, HIPAA, ACA, and other relevant regulations.
- •Oversee end-to-end performance of CMAS functions including claims audit, appeals, escalations, recoveries, subrogation, and NSA.
- •Direct workforce and capacity planning, driving process improvement and automation.
- •Manage the Plan Documents Manager and CMAS Manager, setting clear performance expectations and fostering a culture of accountability.
- •Requirements 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations. 5 years of leadership experience managing managers or teams.
- •Deep knowledge of ERISA, Internal Revenue Code, HIPAA, MSP, COBRA, ACA, and WHCRA.
- •Demonstrated experience overseeing plan document drafting and claims ancillary functions.
- •Strong data literacy and experience partnering with Legal, Compliance, and Client Success teams.
Required skills
HIPAASQLCompliance ManagementContract ManagementRisk Management
Nice-to-have skills
Product ManagementProgram ManagementProject ManagementCustomer SuccessImplementation Management
Domain expertise
healthcare
Tech stack
HIPAASQL