--- title: 'Benefit Plan Configuration Specialist - Plan Build at Centivo' canonical: 'https://feeny.ai/job/benefit-plan-configuration-specialist-plan-build-centivo-remote-z0kwbxn890ng' type: 'job' last_seen: '2026-11-03' --- # Benefit Plan Configuration Specialist - Plan Build at Centivo - **Company:** Centivo - **Location:** Remote - **Compensation:** $30–$35/hr - **Employment:** full-time - **Work type:** remote - **Posted:** 2026-10-05 - **Last confirmed live:** 2026-11-03 - **Apply:** https://jobs.ashbyhq.com/centivo/65ee4f56-cca2-4754-b69b-c6660bb16c3d ## Job description 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. 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: As a Benefits Plan Configuration Specialist, you will focus on understanding, translating, and configuring medical and dental plan designs into the core claims platform to ensure accurate processing of claims. You will maximize effectiveness of the core claims platform by continuously evaluating current processes and business needs along with system capabilities. You will create logic sets, based on code mapping, with an emphasis on accuracy and proficiency. Responsibilities Include: - Create the blueprint for configuration of the plan from plan documents and/or plan standards. - Build, validate and test medical and dental plan benefits and associated code mapping logic. - Make necessary plan building and logic revisions when plans are amended. - Build auto-adjudication logic and test for integration with plan. - Resolve system issues and act as contact for opening and closing jobs on the core claims platform job list. - Test open jobs on new releases from the core claims platform and troubleshoot problems prior to loading into production. - Troubleshoot system problems, develop resolutions and/or “work around” procedures. - Work with Department Managers, Team Leaders, and other applicable personnel to improve efficiency within the company. - Coordinates the development of solutions for system related issues that may prevent the use of automated or standard processing methods. - Communicate changes to other departments and help with any required training necessary because of system changes. - Maintain the claim system Plan Building mailbox to research and resolve system issues. Qualifications: Required Skills and Abilities: - Knowledge of professional and institutional claims adjudication. - Ability to interpret plan documents and amendments and translate benefits to ICD 10, HCPCS, CPT, CDT and other insurance billing codes. - Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner. - Ability to adapt to a constantly changing environment. - Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions. - Demonstrated ability to work in a fast-paced, agile environment managing multiple issues with pressure of production schedules and deadlines. - Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams. - Proficiency in Microsoft Office applications and other web-based software applications. - Ability to learn new proprietary computer systems. Education and Experience: - Prior experience with a highly automated and integrated claim adjudication systems. - Prior experience in a start-up environment is a plus. Preferred Qualifications: - 4 to 5 years of health insurance related Plan Building experience with TPA and Self-Funding processes. - Associates or Bachelor’s degree preferred. Work Location: - An ideal candidate would be assigned to the Buffalo Office with ability to work from home. - This position is remote or hybrid. Centivo Values: - Resilient – This is wicked hard. There is no easy button for healthcare affordability. Luckily, the mission makes it worth it and sustains us when things are tough. Being resilient ensures we don’t give up. - Uncommon - The status quo stinks so we had to go out and build something better. We know the healthcare system. It isn't working for members, employers, and providers. So we're building it from scratch, from the ground up. Our focus is on making things better for them while also improving clinical results - which is bold and uncommon. - Positive – We care about each other. It takes energy to do hard stuff, build something better and to be resilient and unconventional while doing it. Because of that, we make sure we give kudos freely and feedback with care. When our tank gets low, a team member is there to be a source of new energy. We celebrate together. We are supportive, generous, humble, and positive. 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](http://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. ## About Centivo ## Company Overview - **One-liner**: Centivo designs primary-care-centered health plans for self-funded employers, sold through benefits brokers and consultants, aiming to lower healthcare costs and improve outcomes. - **Entity Type**: Private (funded) - **Headquarters**: Buffalo, New York, USA (with an office in New York City) - **Founded**: 2017 - **Founders**: Ashok Subramanian (CEO) ## Core Business - **Primary industry/industries**: Healthcare (Health Insurance / Health Plan Administration) - **Target customers**: B2B; self-funded mid-market and large employers (50+ employees) and the benefits brokers/consultants who serve them. - **Mission or purpose statement**: To provide people with the healthcare they deserve by building a primary-care-centered health plan that lowers costs and improves outcomes for employers and employees. ## Products & Services - **Primary-Care-Centered Health Plan**: A self-funded health plan for employers. The model centers on a committed, outcomes-driven primary care team. Every member selects a PCP who acts as a care coordinator, managing referrals and follow-ups to reduce fragmented, expensive care. The plan features $0 primary care, low-cost generics, and no deductibles on many services, making it affordable for employees to use. - **Virtual Primary Care**: An integrated, PCMH-recognized virtual primary care practice for remote care. - **Member App**: A simple app for plan usage, with predictable costs and integrated virtual care. ## Market Standing - **Valuation/Market Cap**: Not publicly available (private company). - **Key Metric**: Total Funding (amount not publicly disclosed in search results). The company is funded by private equity and venture capital. - **Notable Investors/Partners**: Not explicitly named in the provided search results, but the company is backed by private equity and venture capital. - **Growth Signals**: The company is expanding nationally, with availability in 14 states (California, Colorado, Connecticut, Florida, Iowa, Kansas, Missouri, New Jersey, New York, North Carolina, Pennsylvania, Texas, Washington, Wisconsin). It reports average employer savings of ~15-30% and an average annual employee out-of-pocket cost of $409 (compared to an industry average of $1,650). The leadership team includes a new President & COO, Jim McNary, to accelerate national expansion. ## Competitive Advantages - **Primary-Care-First Model**: A strong focus on primary care as the central point of coordination reduces unnecessary specialist visits, imaging, and ER use, directly lowering costs. - **Cost Transparency & Savings**: Employers save ~15-30% compared to traditional fully-insured plans. Employees benefit from $0 primary care, low-cost generics, and an average annual out-of-pocket cost of $409 (vs. $1,650 industry average). - **Self-Funding Accessibility**: Makes self-funding accessible for mid-market employers (50+ employees) by handling plan administration, network, and care coordination, with stop-loss insurance for catastrophic claims. - **Curated Provider Network**: Partners with health systems that meet stringent price and quality standards, with a laser focus on primary care. ## Strategic Focus - **National Expansion**: Actively expanding into new U.S. markets, with a current presence in 14 states. The hiring of a President & COO signals a focus on scaling operations. - **Product & Technology Development**: Continued investment in its technology platform, including the member app and virtual care capabilities, to improve member experience and operational efficiency. - **Deepening Broker & Consultant Relationships**: The company is sold through benefits brokers and consultants, indicating a strategic focus on strengthening these partnerships to drive growth. ## Why Work Here - **Culture**: Described as mission-driven, with a focus on changing the healthcare system. The culture values resilience, positivity, and being "uncommon." Team members are encouraged to speak up and share ideas regardless of title or tenure. The company emphasizes Diversity, Equity, Inclusion, and Belonging (DEIB). - **Work Model**: Hybrid/remote-friendly. With headquarters in Buffalo and an office in New York City, the company has team members spread across the country. They use technology and regular company-wide "Huddles" to keep everyone connected and engaged with senior leadership. - **Benefits**: Offers great medical coverage (including the Centivo plan), dental, vision, life and disability insurance, a 401(k) plan, commuting and dependent care FSA, generous parental leave, and time off policies. Team members also have the opportunity to earn bonuses and equity. - **Career Development**: The company encourages hands-on development and a culture where everyone can speak up and share ideas. They believe in building on existing skills and growing through new experiences. - **DEIB**: The company has formal processes and programming to support Equity, Inclusion, and Belonging, valuing individuals for their whole selves across all facets of identity. ## Sources 1. [centivo.com](https://centivo.com/) 2. [centivo.com/working-at-centivo](https://centivo.com/working-at-centivo/) 3. [linkedin.com](https://www.linkedin.com/company/centivo) 4. 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