Director Claims Management Ancillary Services (CMAS)

Responsibilities

• Own the strategy, quality, and regulatory compliance of plan document functions, including SPDs, SMMs, and SBCs
• Ensure compliance with ERISA, Internal Revenue Code, HIPAA, MSP, COBRA, ACA, and WHCRA
• Oversee claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA) functions
• Establish operational and quality KPIs and monitor performance using data
• Manage the Plan Documents Manager and CMAS Manager, providing coaching and performance feedback
• Partner with Legal, Compliance, and Client Success to translate plan changes into accurate documentation
• Drive process improvement, workflow standardization, and AI-enabled enhancements

Requirements

• 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations
• 5 years of leadership experience managing managers or supervisors
• Deep knowledge of ERISA, HIPAA, COBRA, and the ACA as they apply to employer-sponsored benefit plans
• Experience overseeing plan document drafting (SBCs, SPDs, SMMs) in a self-funded or TPA environment
• Bachelor's degree required

Preferred Qualifications

• Employee benefits paralegal background
• Experience with Phia Group's PDM portal or similar management systems
• Experience with claims adjudication systems like Javelina or Health Rules Payer
• Experience leading claims system implementations

About the Company

Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to millions. Centivo saves employers 15 to 30 percent compared to traditional insurance carriers through a primary care based ACO model.