Centivo

• As a Claims Business Analyst, you will be responsible for triaging operational issues and leading projects and tasks to completion. • You will use your claims adjudication experience and TPA background to triage operational concerns, vendor issues, and related claims issues. • 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. • This role ensures seamless integration between internal and vendor systems to support client requirements and operational workflows. • Additionally, you will lead key projects and tasks identified to improve efficiency of Centivo’s Claim team. • This role will use data analytics and other tools to identify areas of improvement needed in the business, scope out the initiative, and then lead the project through to completion.

• Adjudicating claims in assigned work queues based on Centivo’s written Policies and Procedures and the terms of the Summary Plan Documents (SPD’s) for Centivo’s clients. • Diligently reviewing all system-generated edits which have been applied to claims in the Claims Adjustor’s assigned queues prior to releasing the claims to ensure benefits are being applied per the client’s SPD and client funds are being appropriately managed. • When the Claims Adjustor believes there may be an issue or inconsistency in the interpretation of a Plan as the system is applying benefits, immediately route the claim to the Plan Build/System Configuration Team for resolution. • When the Claims Adjustor is unable to resolve an edit based on the provider selection, the pricing and/or usual and customary discrepancies, immediately route the claim to the Provider Maintenance and/or Pricing teams for resolution. • When the Claims Adjustor is unable to resolve an edit based on the information included with or attached to a claim, appropriately deny the claim for additional information, and generate correspondence to the participant or provider concisely explaining data needs. When such additional data is received, reopen the denied claim, and re-adjudicate based on the information. • Maintain daily, weekly, and monthly required production levels documented in Claims Department Policies and Procedures. • Participation in Departmental quality improvement efforts and bring forward process improvement suggestions that will improve efficiencies; question a process or policy that creates additional steps or work on the Claims Adjustor and suggest an alternative solution. • Processes claims in accordance with established policies and procedures, contacting providers as needed, completing tasks under moderate supervision. Responsible for meeting the production and quality goals determined by the department leadership. • Increased responsibilities, which may include assisting and mentoring less experienced team members, participating in various initiatives or projects within the Claims Delivery Team, documenting processes, performing advanced tasks, supporting high-dollar reviews, and overpayments/refunds.

• Develop, document, and maintain end-to-end claims business processes and workflows, ensuring clarity, accuracy, and usability for claims team members. • Test claims workflows in Javelina and HRP to confirm processes function as designed and align with system configuration. • Document all new claims processes step-by-step in Confluence for use by claims team members when adjudicating claims. • Ensure documentation follows instructional design principles, is written in execution order, and includes screenshots as appropriate. • Own and manage all existing claims process documentation in Confluence, (in addition to including creating new documentation) including editing existing content, archiving outdated materials, deleting obsolete content, etc. • Build and maintain an intuitive documentation structure and search taxonomy to ensure ease of use and accessibility. • Create training and reference materials for the Claims organization, including Processors, Auditors, Recovery Analysts (including NSA and Subrogation), Appeals. • Design and deliver specialty claims training as needed to support new processes, system changes, or operational initiatives. • As needed, support training and onboarding of Claims new hires. • Partner with POP, Core Platform, and PMO teams to ensure claims process documentation aligns with new hire training, system configuration, and operational standards. • Partner with POP as a subject matter expert to ensure claims process and adjudication content is accurate, providing quality review of new hire and enhanced training materials (including COB, adjustments, and corrected claims) and advising on the appropriate sequencing of content within new hire training. • As needed, support claims operations by processing claims to assist with workload coverage and inventory management.

• Serve as the primary executive point of contact and trusted advisor for a portfolio of large, national self-funded employer clients, owning the overall health, satisfaction, and growth of each relationship. • Build and maintain multi-threaded relationships across client organizations — including C-suite, VP-level HR and Benefits leaders, and Finance stakeholders — through proactive, strategic engagement and a deep understanding of each client’s business priorities. • Engage regularly with brokers, consultants, and benefits advisors aligned to national accounts, serving as a knowledgeable partner who reinforces the value of the Centivo solution at every touchpoint. • Identify and drive opportunities to expand and deepen each client relationship, including increased enrollment, plan design enhancements, geographic growth, and new program adoption. • Champion the client’s voice internally, advocating for their priorities across Centivo’s product, clinical, operations, and executive leadership teams. • Lead the end-to-end renewal strategy for each national account, developing a client-specific approach that demonstrates measurable plan performance, validates savings against benchmarks, and positions Centivo for long-term retention. • Design and deliver executive-level renewal presentations and business reviews that translate complex data — including claims analytics, cost benchmarking, clinical outcomes, and member engagement metrics — into a compelling, consultative narrative tailored to each client’s goals. • Proactively identify and mitigate retention risks well in advance of renewal windows, drawing on stakeholder intelligence, utilization trends, and account health signals. • Act as a strategic consultant to clients evaluating plan design changes, benefit expansions, or program enhancements, providing informed recommendations grounded in Centivo’s data and industry best practices. • Represent the client success experience in finalist presentations and strategic sales pursuits, providing prospective national account clients with confidence in Centivo’s service model. • Orchestrate a seamless, high-touch service experience for national accounts, coordinating across Centivo’s internal teams and vendor ecosystem to ensure exceptional delivery across all plan components — including member engagement, claims operations, PBM, provider network, and reporting. • Establish clear operating rhythms, escalation protocols, and communication standards with each client, ensuring consistent and proactive account management throughout the plan year. • Personally oversee the identification, tracking, and resolution of high-stakes client issues — including claims discrepancies, executive-level member escalations, and provider disputes — mobilizing the right resources and maintaining transparent client communication throughout. • Leverage deep knowledge of self-funded plan administration and health plan operations to educate clients, contextualize plan data, and proactively address questions before they become concerns. • Drive a data-informed account management approach, using plan analytics, population health trends, and benchmarking data to proactively surface insights and shape client conversations. • Oversee the preparation and delivery of customized performance reporting and executive dashboards for national account clients, ensuring that data is presented clearly, accurately, and in a format that informs strategic decisions. • Collaborate with internal analytics, clinical, and product teams to develop account-specific reporting that reflects each client’s defined success metrics and organizational priorities. • Monitor emerging data signals — including high-cost claimants, utilization patterns, and care gap trends — and translate findings into actionable recommendations for plan sponsors. • Serve as an ambassador for Centivo’s brand and mission within each national account, ensuring that the client’s internal teams, employees, and leadership understand the full value of the Centivo solution. • Maintain a deep understanding of the competitive landscape for large, self-funded employers — including alternative funding models, TPA trends, and evolving broker/consultant expectations — to strengthen Centivo’s positioning within your book of business. • Contribute insights from national account relationships to Centivo’s product and market strategy, serving as a key conduit between large client needs and internal roadmap priorities.

• Own the full lifecycle of Centivo's stop loss and captive product offerings — from program structure and feature design through launch, iteration, and ongoing performance management. • Define and maintain product specifications for specific stop loss coverage, aggregate stop loss, and captive arrangements, ensuring terms, attachment points, and program features are competitive and financially sound. • Lead the evaluation and design of level funding, minimum premium, and partial self-funding structures as differentiated market offerings. • Build and maintain a prioritized product roadmap for the risk management domain that balances underwriting discipline with market competitiveness. • Translate emerging trends in stop loss, reinsurance, and captive markets into actionable product initiatives. • Partner with underwriting to develop and refine risk selection criteria, pricing frameworks, and program structures — including layered and quota share approaches. • Define product guardrails that support sound underwriting outcomes while giving sales and client management the flexibility to compete effectively. • Lead product strategy for captive program creation, management, and redesign. • Define the criteria and structure for new captive formations, assess performance of existing captives, and drive product changes that optimize outcomes for captive members. • Define product requirements for reinsurance arrangements that support Centivo's risk portfolio. • Work across finance, underwriting, actuarial, network and teams to ensure risk product designs are operationally viable and financially modeled accurately. • Monitor the stop loss carrier, MGU, and captive market landscape. • Define the metrics that indicate healthy risk product performance and use them to drive ongoing product decisions. • Represent Centivo's risk management product capabilities externally with brokers, consultants, reinsurers, and at industry forums.

Role Description As a full-time Health Navigator, you will play a key role in our virtual day-to-day operations of our national virtual primary care practice. You will work closely with a close-knit clinical and operations team, contributing to a meaningful workplace and clinical experience supporting patients and providers within our advanced virtual primary care practice. This role combines administrative coordination, patient communication, and light clinical navigation, ensuring patients receive seamless, timely, and high-quality care. Ideal candidates have prior Medical Assistant experience, strong communication skills, and comfort working in a fast-paced, technology-enabled environment. Excellent candidates will exemplify a passion for delivering exceptional patient experiences, building trust, and having a “no task is too big or too small” attitude. Qualifications - Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), or equivalent clinical background and/or work experience. - 2+ years of experience in primary care, ambulatory, or virtual care setting. - Strong EMR experience (Athena preferred). - Excellent communication and organization skills. - Demonstrated ability to multitask and prioritize in a virtual, fast-paced environment. - Willingness to learn and collaborate with your team. - Spanish-speaking preferred. - Open to travel for specific marketing or clinical events up to 2x/month. - Experience with telehealth platforms and digital patient communication tools. - Familiarity with referral management, insurance eligibility verification, and prior authorizations. - Knowledge of HIPAA and patient privacy best practices. Requirements - Provide coverage during business hours to manage incoming patient messages and requests. - Assist patients with scheduling, rescheduling, and confirming appointments. - Answer patient administrative questions and escalate clinical questions appropriately. - Conduct outbound communication to patients by phone as appropriate. - Call labs or pharmacies for refills, clarifications, or updates as directed by providers. - Contact patients and providers to gather necessary clinical or administrative information. - Triage patient requests, escalating urgent medical needs to same-day visits or to the provider team for guidance. - Create and route patient cases in the EMR to the appropriate providers or care team members. - Facilitate specialty and imaging referrals, ensuring referral orders are completed, faxed, and communicated to patients and facilities. - Manage closed-loop referral follow-up, retrieving specialist consult notes and ER discharge summaries. - Support prior authorization workflows for medications as directed. - Update pre-visit information prior to scheduled appointments including ensuring eligibility, demographics, preferred lab/pharmacy, etc. - Support patients virtually to obtain, document, and report accurate vital signs. - Obtain, document, and report basic medical, social, and family history. - Provide patient education on topics such as blood pressure monitoring and glucometer usage if needed. - Manage medical record requests from patients and externally (labs, specialists, etc). - Retrieve and upload records, lab results, and hospital discharge summaries to the EMR. - Provide cross-coverage across care teams as needed. - Respond to and resolve patient voicemails, messages, etc. - Collaborate with providers and operations teams to maintain smooth care coordination. - Initiate, track, and follow up on specialty and imaging referrals. - Communicate with community specialists by phone and prioritize urgent referrals when needed. Benefits - Competitive salary. - Comprehensive health benefits. - Flexible work environment. - Opportunities for professional development. Company Description 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. 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.

• Define and execute the reporting and analytics strategy aligned to organizational priorities, with a product mindset that emphasizes reusability, consistency, and scalability across the enterprise. • Establish and maintain a standard library of reporting insights, including a semantic layer of measures and models, designed to meet the majority of recurring reporting and analytics needs across the organization and in-the-moment ad-hoc analyses. • Drive enterprise-wide data literacy and self-service analytics capabilities, enabling teams to access, interpret, and act on data confidently without requiring analyst intermediation for routine decisions. • Champion a culture of insight-to-action — ensuring analytics findings are translated into clear strategic and operational recommendations that business leaders can act on decisively. • Lead the team’s evolution toward AI-enabled analytics capabilities in accordance with Centivo’s AI Governance and Acceptable Use policies. • Serve Employers, Brokers, Client Success, and Centivo Corporate in highlighting Centivo’s value — proactively creating and managing standard insights and delivering urgent and advanced analysis for clients and corporate stakeholders. • Serve internal stakeholders (e.g. Claims Operations, Member Operations, Care, Provider, Finance, etc.) by delivering operational performance insights and supporting data driven planning — predominantly developing standard insights for self-service by internal users, with ad-hoc delivery as prioritized. • Partner directly with senior leaders across Claims Operations, Member Operations, Care, Finance, Sales & Marketing, and Centivo Corporate to translate business priorities into actionable analytics capabilities. • Ensure proactive, ongoing engagement Client Success — anticipating stakeholder needs and maintaining alignment on priorities. • Collaborate closely with the head of data architecture (Datalake team) to ensure alignment between analytics products and the underlying data infrastructure, governance standards, and platform roadmap. • Own the BI infrastructure strategy, including sourcing, integration and ongoing management of third-party BI tools and metrics/models that enable scalable and differentiated insights. • Lead BI tool migration efforts, ensuring continuity of reporting capabilities while improving scale, performance, and usability. • Identify and propose analytical solutions that leverage corporate, clinical and third-party data assets to drive measurable business outcomes. • Own accountability for delivery against time and quality SLAs across standard and ad-hoc analytics requests. • Lead execution of a prioritized portfolio of analytics initiatives; establish process discipline to ensure consistent, high-quality output at scale. • Drive automation — including AI-assisted workflows — to reduce errors, improve productivity, and increase the team’s overall capacity for higher-value analysis. • Define and track key performance metrics across analytics value streams; course-correct proactively when performance deviates from plan. • Directly manage and develop a team of data analysts, providing coaching, performance oversight, and career development aligned with Centivo’s leadership behaviors and growth objectives. • Build and maintain a high-performing analytics organization; model Centivo’s values and leadership behaviors consistently. • Manage vendor relationships related to BI tooling and third-party data/model providers, including oversight of contracts, statements of work and delivery performance.

• Own the day-to-day administration of Salesforce, including user setup, permissions, objects, page layouts, and system configurations. • Build, maintain, and optimize complex Flows, validation rules, and other automation within Salesforce. • Troubleshoot and resolve system issues, including identifying and debugging automation conflicts. • Support enhancements to business processes using Salesforce as a core system of record. • Translate business requirements into scalable Salesforce solutions that support operational efficiency and business goals. • Improve workflows across lead management, pipeline management, renewals, customer lifecycle, and other operational processes. • Identify process inefficiencies and recommend scalable improvements. • Ensure data accuracy and consistency to support reporting, forecasting, and business decision-making. • Support executive-level reporting needs through accurate, timely, and actionable Salesforce reporting. • Support lead flow, data enrichment, and deduplication processes across integrated systems.

• Partnering with business stakeholders and subject matter experts to gather, document, and validate requirements, and translate them into technical data specifications, KPIs, and user outcomes. • Architect end-to-end solution covering data sourcing, scalable data models, metric definitions, and dashboard layouts that are scalable, accurate, user-friendly, and visualize trends effectively. • Build reports, dashboards, and analytical datasets; write optimized SQL and leverage company approved BI tools to deliver market-facing and internal analytics capabilities. • Conduct rigorous data validation and user acceptance testing (UAT); verify metric logic, source-to-target accuracy, and dashboard functionality before release. • Manage the deployment of new reports and dashboards through defined release processes; communicate with stakeholders to ensure access control, user training, and timely delivery. • Monitor and sustain the health of existing reporting assets; troubleshoot data and dashboard issues, identify root causes, and implement technology or process fixes to ensure ongoing reliability. • Continuously evaluate existing analytics capabilities for improvement opportunities; incorporate stakeholder feedback, evolving business needs, and new data sources to expand analytical value. • Provide training and support to end users on utilizing and interpreting reports and analytics. Write user-friendly documentation to help self-serve. • Deliver urgent business needs through rapid ad-hoc queries, report creation, and data analysis. • Perform continual analysis of current performance, utilizing historical trends, and conduct frequent re-forecasting to make necessary adjustments in staffing plans to achieve service level goals and business objectives. • Support internal teams by using data and root cause analysis to recommend process changes that improve SLAs and operational efficiency. Reduce manual effort by automating needs for insights through BI tools, scripting, and improved data pipelines. • Contribute to assigned special projects and transformation initiatives.

• Report to the Head of Product and play a lead role in shaping Centivo's product marketing function. • Develop a deep understanding of our audiences, including their needs, goals and challenges, and translate these into actionable insights to improve marketing effectiveness and product development. • Develop value propositions that resonate with our audiences by clearly describing how our products and services solve their challenges, highlighting features and benefits that are differentiating in the market. • Understand the competitive landscape and enable our National Account Sales team to communicate how our product is better positioned to solve our customers' challenges than competitors' products. • Develop National Account sales decks, product demos and collateral (e.g., case studies, sell sheets) that enable Sales to clearly communicate how our product solves our customers' challenges, close deals faster and improve conversion rates. • Create product packages and pricing aligned to audiences, considering their needs and competitor pricing to close deals faster and improve conversion rates. • Create co-marketing partnership opportunities that also serve our audience. • Manage product launch efforts in collaboration with Product and other marketing teams, determining appropriate launch strategy and plan for each product release/feature, in the context of broader product positioning and messaging narrative. • Design and deliver quarterly and annual GTM retrospectives based on closed/won analysis and interviews, internal surveys, and demand gen programs/campaign learnings. • Collaborate with the rest of the marketing teams to develop content and campaigns with messaging that resonates with our audiences.