• Advanced-level role responsible for auditing and evaluating internal Commercial claims operations and Third-Party Administrator (TPA) claim handling performance • Analyze adherence to claims handling standards, regulatory requirements, SLAs, and KPIs • Identify operational, compliance, and claim quality risks and provide recommendations for improvement • Develop and enhance audit methodologies, scorecards, reporting tools, and operational dashboards

• Test and maintain health insurance benefit plans in the company's systems, ensuring accuracy and compliance with regulatory requirements. • Conduct regular audits and reviews of benefit configurations to identify discrepancies, inconsistencies, or errors. • Resolve configuration errors in a timely manner and document changes. • Work closely with IT teams to ensure seamless integration of benefit configurations into the company's technology platforms. • Maintain comprehensive documentation for benefit configuration, ensuring that processes and procedures are well-documented. • Evaluate and validate all medical billing codes, various coding services and align to accurate benefit coding. • Perform audits on all clinical documents and prepare coding to provide support to all services. • Perform research on various coding methods and facilitate all plans to resolve all discrepancies and coordinate with all clinical and non-clinical groups to manage documents according to required guidelines. • Administer review of professional billing systems and perform research to resolve all coding errors and evaluate all claims work queues. • Review procedure code master file and evaluate authenticity of all entries and evaluate all through efficient usage of codes. • Analyze and maintain all code master files for all inappropriate codes and inform staff for same and collaborate with staff to resolve all coding issues and ensure accuracy of same. • Perform testing of coding and policy changes via reports, claim adjudication and other testing software. • Manage and resolve all discrepancies in entry of codes and maintain knowledge on all procedural codes and reimbursement plans and prepare reports for all coding guidelines. • Maintain knowledge and compliance of CMS (Center for Medicare Services) guidelines and coding/billing processes. Ensure compliance with other insurance governance agencies. • Participate in and support all training in regard to new benefit designs or benefit changes as the result of CMS or other insurance regulations.

Role Description Estamos buscando un/a Analista Cobol CICS Db2 para incorporarse a un proyecto estable y de largo recorrido, participando en la definición funcional y técnica de soluciones dentro de un entorno Mainframe. - Personas con iniciativa, autonomía y capacidad de liderazgo técnico. - Profesionales que asuman la responsabilidad de sus proyectos y sean capaces de impulsar las tareas de principio a fin. - Capacidad para desenvolverse con independencia y tomar decisiones dentro de su ámbito de responsabilidad. - Actitud resolutiva y orientación a la mejora continua. - Excelente capacidad de comunicación y colaboración con equipos multidisciplinares. Qualifications - Experiencia mínima de 5 años como Analista en entornos Mainframe. - Experiencia previa demostrable en Cobol-CICS-DB2. - Capacidad para analizar requerimientos funcionales y transformarlos en especificaciones técnicas. - Experiencia en interlocución con usuarios y áreas de negocio. - Capacidad para trabajar de forma autónoma, tomando decisiones y gestionando iniciativas con mínima supervisión. - Perfil proactivo, resolutivo y orientado a resultados. Requirements - Análisis funcional y técnico de requerimientos. - Diseño de soluciones en entornos Cobol, CICS y Db2. - Elaboración de documentación funcional y técnica. - Coordinación con equipos de desarrollo, usuarios y áreas de negocio. - Supervisión de pruebas y soporte a la implantación. - Identificación de mejoras y optimización de procesos y aplicaciones. - Liderar de forma autónoma el análisis y seguimiento de las iniciativas asignadas. - Proponer mejoras funcionales y técnicas que aporten valor al negocio. - Garantizar la calidad de las soluciones y el cumplimiento de los plazos establecidos. Benefits - Un entorno de trabajo excelente. - Oportunidades de desarrollo profesional y crecimiento continuo. - Contrato indefinido y modalidad de trabajo en remoto desde España o Andorra. - Soporte para capacitación y certificaciones.

Role Description Are you a BCBA looking for a workplace that values your expertise, offers strong clinical support, and provides real career growth? At Centria, we prioritize your success by eliminating operational burdens, allowing you to focus on what you do best: delivering exceptional ABA therapy and making a difference in children's lives, in a purpose-built clinical setting. Your Role & Impact as a BCBA: - Deliver high-quality clinical oversight for in-home ABA services via telehealth - Provide remote coaching, supervision, and support to Behavior Technicians in the field - Develop and implement assent-based, individualized behavior plans following ABA principles - Lead virtual family training sessions to reinforce strategies and drive consistency - Maintain high-quality clinical services through regular supervision and data-driven decision-making Compensation and Incentives - Base salary up to $105,000 (based on experience) - Signing bonus - Monthly and weekly bonus structure averaging $1,000 or more per month! What Centria Offers - Flexible, Purposeful Work – Work from home while leading in-home ABA services across multiple locations, ensuring access to care for families in need. - Tech That Works for You – Our proprietary CareConnect platform makes remote supervision, programming, documentation, and progress monitoring seamless and intuitive. - Assent-Based Care, Anywhere – Support in-home teams using Practical Functional Assessment, Skills-Based Treatment, and assent-based practices, delivered in natural environments that support generalization. - Real Work-Life Balance – Predictable caseloads, manageable schedules, and dedicated support teams mean no last-minute chaos and no burnout. - You're Never Alone – With layered support from Clinical Directors, Area Clinical Directors, and our Clinical Excellence Team, you'll always have someone in your corner. - No Operational Headaches – We handle the logistics. From scheduling to onboarding of technicians, our operations team keeps everything running smoothly behind the scenes. - Career Growth on Your Terms – Whether you're mentoring the next generation of BCBAs, leading clinical training, or stepping into leadership, we support your growth. - We Invest in You – From CEU stipends and paid CEU days to exclusive internal training events, we’re serious about keeping you sharp—and helping you level up. - Perks That Actually Matter – Annual, all-inclusive vacation for two, early wage access, a company car or mileage reimbursement, and full benefits. - No Non-Compete – We don’t believe in holding people back. If we’re not the right long-term fit, you’ll still leave better prepared for your next step. Company Description Centria is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.