Claims Recovery Specialist

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.

The Claims Recovery Specialist is responsible for supporting healthcare claims recovery activities, with a primary focus on subrogation, overpayment recoveries, and No Surprises Act (NSA) dispute management. This role partners closely with an assigned third-party vendor and internal stakeholders to research paid claims, gather documentation, coordinate follow-up, manage recovery-related inventory, and ensure internal and regulatory timeframes are met.

The ideal candidate has direct experience in healthcare claims, health plan payer, TPA, or managed care claims operations, including exposure to subrogation, overpayment investigations, and/or NSA-related claim activity. This role requires experience researching paid claims, reviewing claim history, coordinating with internal teams and external partners, and managing multiple cases while meeting required turnaround times. This is a specialized claims operations role and is best suited for candidates with healthcare claims recovery experience rather than general analyst or provider billing backgrounds.

Responsibilities Include:

• Prepare and review claim history, supporting documentation and related case materials for overpayment, subrogation, and NSA recovery matters.

• Research paid claims and investigate recovery opportunities using available systems, documentation, and internal resources

• Communicate recovery interest to assigned vendors and clients; support discussions related to settlement activity and case progression

• Facilitate meetings and calls between Centivo, third-party vendors, and clients to obtain final approvals and move cases toward resolution

• Adjust claims and document case activity as needed based on overpayment findings, settlement activity, or NSA/subrogation outcomes

• Maintain accurate and timely documentation, tracking, and data entry for assigned recovery-related cases

• Monitors daily and weekly inventory to ensure internal and regulatory timeframes are met

• Identify trends or recurring issues and escalate opportunities for process improvement, quality enhancement, and operational efficiency

• Perform other duties as assigned

Qualifications:

Required Skills and Abilities:

• Strong verbal and written communication skills; with the ability to explain claim-related and regulatory information clearly and professionally

• Strong analytical and problem-solving skills, with the ability to review claim details, identify discrepancies, and determine appropriate next steps

• High level of organization and attention to detail in a fast-paced environment with competing priorities

• Working knowledge of healthcare claims processes and basic concepts related to subrogation, overpayments, and No Surprises Act disputes

• Ability to identify urgent situations, exercise sound judgment, and follow established escalation protocols

• Ability to produce clear, accurate, and professional business correspondence

• 3Ability to manage multiple cases and deadlines while maintaining accuracy and consistency. Requires the ability to plan, manage multiple priorities, and deliver complete, accurate, and timely results in a fast-paced office environment.

Education and Experience:

• High School diploma or equivalent required; Associate degree preferred

• At least 1 year of experience in health plan payer, TPA, managed care, or healthcare claims operations

• At least 1 year of direct experience in subrogation, overpayment recovery, NSA dispute handling, or related claims recovery work

• Additional relevant experience or training may be considered in lieu of formal education.

Preferred Experience:

• Experience working with payer-side claims recovery vendors=

• Experience handling or supporting No Surprises Act dispute workflows

• Experience with claim adjustments, recovery tracking, and regulatory turnaround requirements

Work Location:

Candidates located within commuting distance of our Buffalo office will be considered for both in-person and hybrid roles. All other applicants will be considered for remote positions.

Who we are:

Centivo 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. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.

Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.