Director Claims Management Ancillary Services (CMAS)
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:
The Director, Claims Management Ancillary Services (CMAS) owns the strategy, performance, and compliance of Centivo's claims ancillary functions, with particular emphasis on the Plan Documents function. This role directly manages the Plan Documents Manager and the CMAS Manager and is accountable for the accuracy, timeliness, and regulatory compliance of Centivo's plan documents -- including SBCs, SPDs, SMMs, and amendments -- as well as the performance of claims audit, appeals, escalations, recoveries, subrogation, and NSA functions.
The Director translates departmental and organizational strategy into executable plans, builds a high-performing and accountable team, and serves as the operational authority for CMAS and Plan Documents with clients, brokers, agents, TPAs, and stop loss carriers.
Responsibilities Include:
Plan Documents Strategy & Compliance
- Own the strategy, quality, and regulatory compliance of Centivo's plan document function, including Summary Plan Descriptions (SPDs), Summary of Material Modifications (SMMs), plan amendments, and Summary of Benefits and Coverage (SBCs)
- Ensure plan document processes and content remain current with the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code, HIPAA, the Medicare Secondary Payer Act (MSP), COBRA, the Affordable Care Act (ACA), and the Women's Health and Cancer Rights Act (WHCRA)
- Establish document governance standards, review workflows, and quality checkpoints to ensure plan documents are accurate, complete, and audit-ready across all clients and plan types
- Partner with Legal, Compliance, Configuration, and Client Success to translate client implementations, plan changes, and regulatory updates into accurate pl...