System Configuration Manager - Health Plan Benefits

Centivo

Centivo

Accounting & Finance
Buffalo, NY, USA
Posted on Friday, May 24, 2024

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.

Centivo is looking for a System Configuration Manager to join our team!

As a System Configuration Manager you will play a pivotal role in managing the day-to-day operations of the Plan Build and Enrollment teams. You will collaborate with all business units, including the Plan Document, Implementation, Client Success, and Product teams to ensure superior output, client experience, and satisfaction. Additionally, you will coordinate with external vendors to meet client needs and establish operational processes. You will provide leadership and coaching to the Team Leads, to maximize performance of the entire team. The Configuration Manager is a key member of the Client Delivery & Operations team, managing configuration for plan, benefits and enrollment related to client implementations, renewals and changes.

What you’ll do:

  • Manage the workload and task assignments of the Plan and Enrollment configuration teams.
  • Identify workflow process improvements, working with the management team to implement changes and/or create policies, procedures and job aids.
  • Establish quality assurance metrics and tracking mechanisms to identify training opportunities and optimize performance.
  • Attend meetings and collaborate with other departments as needed for representation of the Configuration team.
  • Develop and conduct training for team members.

Plan Configuration Team responsibilities include:

  • Creating the blueprint for configuration of the plan from plan documents and/or plan standards.
  • Build, validate and test medical and dental plan benefits and associated code mapping logic.
  • Make necessary plan building and logic revisions when plans are amended.
  • Build auto-adjudication logic and test for integration with plan.
  • Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list.
  • Troubleshoot system problems, develop resolutions and/or “work around” procedures.
  • Work with Department Managers, Team Leaders, and other applicable personnel to optimize efficiency of the core system and the business.
  • Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods.
  • Communicate changes to other departments and help with any required training necessary due to system changes.
  • Maintain the claim system Plan Building mailbox to research and resolve system issues.

Enrollment Team responsibilities include:

  • Collaborate with Implementation, Client Success, Plan Build and Data Integration teams to configure client account structure and accept group enrollment information.
  • Manage client’s portal access.
  • Manage enrollment and COB for members.
  • Monitor and manage electronic claim receipts.
  • Manage and configure ID cards and EOBs to client specifications.
  • Review client census for audit and billing purposes.
  • Identify potential claims impact due to eligibility updates.
  • Research and resolve file feed issues, collaborating with other departments to determine root causes.

You should have:

  • In-depth knowledge of medical/health plan and benefits, TPA and self-funding processes.
  • The ideal candidate should have minimum of 3 years experience in a leadership role.
  • Exceptional analytical skills with a data-driven approach to optimize operational performance and make decisions.
  • Demonstrated abilities with process development and optimization as well as change management.
  • Excellent written, verbal, and interpersonal communication skills.
  • Ability to manage time effectively, set priorities effectively and meet deadlines.
  • Advanced knowledge of Microsoft Office products (Excel, PowerPoint, Word).
  • Demonstrated ability to meet and manage performance goals, including accuracy and productivity.
  • Ability to take initiative and be self-motivated while exercising proactivity in problem-solving and appropriate decision-making.
  • Comfortable working in a dynamic and fast-paced environment, with the ability to adapt to evolving priorities.
  • Proven ability to lead and inspire a team, fostering a culture of creativity, collaboration, and excellence.
  • Prior experience with a highly automated and integrated claim adjudication system.

These are not required, but would be nice to have:

  • Javelina experience
  • HRP experience

Location:

  • An ideal candidate would be assigned to the Buffalo, NY Office with the ability to work from home. This position is hybrid.

Pay Transparency
The ranges we place in our job postings reflect what we anticipate to be the minimum to maximum of the base salary for this role. Additionally, our overall benefits package includes a few things you may consider towards a total compensation such as bonus, health benefits (some employer paid), PTO, and equity option grants.

Salary Range
$100,000$110,000 USD

Our 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.