Centivo · 2 days ago
Claims QA Auditor Lead
Buffalo, NY
Full-time
Hybrid
Mid, Senior Level
$65K/yr - $70K/yr
3+ years expCentivo 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. The Claims QA Auditor Lead is responsible for overseeing the daily operation of the Claims Quality Team, managing quality review programs, and ensuring that performance improvement plans are implemented effectively.
Health CareInformation TechnologyMedical
Responsibilities
Oversight and management of the Claims Quality Assurance Team, including mentoring the team, implementing and coaching through performance improvement plans, and training auditors on job performance expectations
Reviewing audits of claims, ensuring processing accuracy by verifying all aspects of the audit have been handled correctly and according to both standard processes and the Client’s summary plan description
Managing the inventory of audits against standard service level agreements (SLA’s) and reporting requirements
Compiling reporting of audits completed, with decision methodology for procedural and monetary errors which are used for quality reporting and trending analysis utilizing quality tools
Identifying trends based on the quality reviews, identifies quality improvement opportunities and partners with training team to develop programs
Partnering with Claims Department Leadership and Training Lead on any problematic issues warranting immediate corrective action
Qualification
Required
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Must possess proven organizational, rational reasoning, ability to examine information, and problem-solving skills, with attention to detail necessary to act within complex environment
Ability to comprehend and produce grammatically accurate, error-free business correspondence required
Ability to appropriately identify urgent situations and follow the appropriate protocol
Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment
Ability to work under limited supervision and provide guidance and coaching to others
Excellent coaching skills and ability to mentor others towards quality improvement
Proficiency in MS Office applications required
High School diploma or GED required
Minimum of three (3) years of experience in a claim examiner or quality assurance role with a health care company, meeting production and quality goals/ standards
Detailed knowledge of relevant systems and proven understanding of processing principles, techniques, and guidelines
Ability to acquire and perform progressively more complex skills and tasks in a production environment
Proficient experience in MS Word, Excel, Outlook, and PowerPoint
Experience with a highly automated and integrated claim adjudication system
Preferred
Associate or Bachelor's degree preferred
Company
Centivo
Centivo offers a digital health plan aimed at self-funded employers looking to provide employees with care.
201-500 employees
H1B Sponsorship
Centivo has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (1)
2023 (2)
2022 (2)
2021 (1)
Funding
Current Stage
Growth StageTotal Funding
$226.4MKey Investors
Morgan HealthB Capital,Maverick VenturesB Capital
2024-09-24Series Unknown· $75M
2024-09-24Debt Financing
2022-07-19Series B· $30M
Leadership Team
Alan Cohen
Chief Product Officer & Co-Founder
Wayne Jenkin
Chief Medical Officer
Recent News
2025-08-26
2025-08-20
Company Ventures
2025-08-12
Company data provided by crunchbase