Claims Adjustor
CentivoEmployer Health company
RemoteMid
Bain Capital Ventures
Bessemer Venture Partners
F-Prime Capital Partners
Maverick Ventures
Ingleside Investors
Rand Capital
Operations & Strategy
About the role
TL;DR
Manage and process healthcare claims for self-funded employer groups.
- •Centivo is seeking Claims Adjustors to manage and process healthcare claims for self-funded employer groups.
- •You will review and adjudicate claims, ensuring timely and accurate payment to providers.
- •Key Responsibilities Adjudicate claims based on Centivo's policies and Summary Plan Documents.
- •Review system-generated edits to ensure accurate benefit application and fund management.
- •Route claims to appropriate teams for resolution of plan interpretation, provider, or pricing discrepancies.
- •Deny claims for additional information when necessary and re-adjudicate upon receipt.
- •Maintain daily, weekly, and monthly production levels and participate in quality improvement efforts.
- •Requirements Prior experience with a highly automated and integrated claims processing system.
- •Experience working with HealthRules Payer is preferred.
- •Knowledgeable about healthcare claims, medical coding, and Benefit Plan rules.
- •Strong critical thinking and decision-making skills.
- •Excellent oral and written communication skills.
Required skills
ExcelPowerPoint
Domain expertise
healthtech
Benefits & perks
Paid training, Free primary care, Predictable copay, No-deductible benefit plan
Tech stack
ExcelPowerPoint
