About the role
We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Summary of role: We are seeking a detail-oriented Claims Process & Training Specialist to design, document, test, and train claims workflows across the organization. This role is responsible for building clear, usable claims process documentation, developing training resources, and ensuring claims processes function as designed within core systems. The ideal candidate is highly organized, process-driven, and comfortable training as well as partnering cross-functionally to support operational excellence within the claims function.
Responsibilities Include: 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in Confluence, (in addition to including creating new documentation) including editing existing content, archiving outdated materials, deleting obsolete content, etc.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.
