Director of Claims Management & Ancillary Services

About the role

Centivo is seeking a senior leader to own the strategy, performance, and regulatory compliance of its claims ancillary services and plan document functions. The Director will guide a high‑performing team, ensure accurate and timely plan documents, and oversee claims audit, appeals, recoveries, subrogation and NSA operations.

Key responsibilities

• Develop and execute the strategy, quality standards, and regulatory compliance for plan documents (SPDs, SMMs, SBCs, amendments).
• Lead end‑to‑end CMAS operations including claims audit, appeals, escalations, recoveries, subrogation and No Surprises Act compliance.
• Establish, monitor, and report operational and quality KPIs across both functions.
• Direct workforce and capacity planning, managing inventory, resource allocation and overtime to balance cost and service performance.
• Drive process improvement, workflow standardization, automation and AI‑enabled enhancements.
• Manage and develop the Plan Documents Manager and CMAS Manager, setting performance expectations and fostering a culture of accountability.

Required profile

• Minimum 7 years experience in employee benefits compliance, plan document administration, or healthcare claims operations.
• At least 5 years of leadership experience managing managers or senior teams.
• Deep knowledge of ERISA, Internal Revenue Code, HIPAA, MSP, COBRA, ACA and WHCRA as applied to employer‑sponsored benefit plans.
• Bachelor’s degree required; paralegal certification or advanced degree preferred.

Required skills

• Experience with plan document management systems such as the PDM portal.
• Proficiency using claims adjudication platforms like Javelina.
• Familiarity with Health Rules Payer or similar claims processing systems.