Claims Business Analyst

We exist for workers and their employers—who are the backbone of our economy. Centivo’s mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

About the role

As a Claims Business Analyst, you will triage operational issues and lead projects and tasks to completion. Using your claims adjudication experience and TPA background, you will address operational concerns, vendor issues, and related claims challenges. 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, ensuring seamless integration between internal and vendor systems to support client needs and operational workflows. Additionally, you will lead key projects to improve the efficiency of Centivo’s Claims team, using data analytics and other tools to identify areas of improvement, scope initiatives, and drive them to completion.

Responsibilities

• Support the Centivo Claims Team with troubleshooting issues, identifying root causes and magnitude, and researching and recommending solutions.
• Work with end-users and operational partners to identify business needs and ensure implementations meet requirements and address prioritized needs.
• Develop and maintain advanced reporting, dashboards, KPIs, and business insights to support operational decision-making and measure process performance and effectiveness.
• Assist with creating process flows for new initiatives and existing processes as needed.
• Act as a liaison between business and technical resources to ensure solutions meet or exceed client and operational needs.
• Pull and analyze daily, weekly, and monthly operational reports to monitor team performance, identify trends, and provide actionable insights to leadership.
• Identify and articulate business requirements in collaboration with business partners.
• Facilitate brainstorming sessions to review solution options for business needs.
• Assist and participate in claims testing for new technology, vendor processes, and system changes.
• Proactively stay informed about vendor enhancements and their integration with existing solutions.
• Collaborate with Subject Matter Experts (SMEs) on all aspects of Claims systems functionality and act as the primary liaison with vendors for reported issues and enhancement requests.
• Oversee the implementation of claims platform upgrades and supporting technologies, including coordinating user acceptance testing with operational leads.
• Proactively identify opportunities and recommend system solutions to increase automation, resolve deficiencies, and enhance claims processing and reporting.
• Participate in the assessment of new technologies, vendors, and system enhancements.
• Engage 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.
• Perform other duties as deemed essential and necessary.

Requirements

• At least 5 years of experience within healthcare claims.
• At least 3 years of experience working as a Business Analyst.
• Prior experience with highly automated and integrated claim adjudication systems.
• Understanding of health insurance benefits administration in a self-funded environment.

Skills

• Advanced problem-solving skills, with a track record of researching and resolving operational issues accurately and on time.
• Highly organized with the ability to work independently, using sound judgment to manage priorities and make decisions.
• Adaptability to changes in the work environment, managing competing demands and unexpected events, including production schedule pressure.
• Ability to build strong working relationships and influence outcomes across cross-functional teams.
• Proficiency in Microsoft Office and other web-based software applications.
• Skilled in running queries and analyzing data to identify trends and issues.
• Excellent verbal and written communication skills, including the ability to explain complex or technical information clearly and interpret complex information from others, such as reimbursement policy standards.

Preferred Qualifications

• Experience working with El Dorado-Javelina or HealthRules Payer.
• Experience working at a TPA (Third-Party Administrator).
• Experience with self-funded plans.
• Proficiency in SQL, Tableau, and JIRA.
• Intermediate to advanced proficiency in MS Excel.

Work Location

Preference for Buffalo Office. Open to remote work.

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 isn’t working for members, employers, and providers. So we’re building it from scratch, from the ground up, focusing on making things better for them while 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 be resilient and unconventional while doing it. Because of that, 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.

About Centivo

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 free primary care (including virtual), predictable copays, and a no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. 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.

Pay

Compensation range: $80,000 – $100,000.