---
title: 'Claims Adjustor at Centivo'
canonical: 'https://feeny.ai/job/claims-adjustor-centivo-buffalo-0vqwqv1pxpv7'
type: 'job'
last_seen: '2026-09-08'
---

# Claims Adjustor at Centivo

- **Company:** Centivo
- **Location:** Buffalo, NY
- **Compensation:** $19–$23/hr
- **Employment:** full-time
- **Work type:** hybrid
- **Posted:** 2026-07-29
- **Last confirmed live:** 2026-09-08
- **Apply:** https://jobs.ashbyhq.com/centivo/5ede4d8b-98b4-4cc3-a2ba-244f446c92b4

## 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.

Centivo is looking for Claims Adjustors to join our team!  Training is paid and begins November 2, 2026.

As a Claims Adjustor, you will manage and process healthcare claims for our self-funded employer groups. Health care providers treat patients, then file medical claims to receive payment from the patient’s Benefit Plan. Claim Adjustors review and assess the claims, adjudicating payment to the provider on behalf of the Plan if a claim is covered by the patient’s Benefit Plan. Claims Adjustors are responsible for working closely with the Claims Supervisor, Account Managers, System Configuration, and Quality Assurance Team in ensuring that claims received by Centivo are adjudicated in a timely manner and accurately. Claims Team roles are based on skill level and increased responsibilities.

What you’ll do:

- Adjudicating claims in assigned work queues based on Centivo’s written Policies and Procedures and the terms of the Summary Plan Documents (SPD’s) for Centivo’s clients.
- Diligently reviewing all system-generated edits which have been applied to claims in the Claims Adjustor’s assigned queues prior to releasing the claims to ensure benefits are being applied per the client’s SPD and client funds are being appropriately managed.
- When the Claims Adjustor believes there may be an issue or inconsistency in the interpretation of a Plan as the system is applying benefits, immediately route the claim to the Plan Build/System Configuration Team for resolution.
- When the Claims Adjustor is unable to resolve an edit based on the provider selection, the pricing and/or usual and customary discrepancies, immediately route the claim to the Provider Maintenance and/or Pricing teams for resolution.
- When the Claims Adjustor is unable to resolve an edit based on the information included with or attached to a claim, appropriately deny the claim for additional information, and generate correspondence to the participant or provider concisely explaining data needs. When such additional data is received, reopen the denied claim, and re-adjudicate based on the information.
- Maintain daily, weekly, and monthly required production levels documented in Claims Department Policies and Procedures.
- Participation in Departmental quality improvement efforts and bring forward process improvement suggestions that will improve efficiencies; question a process or policy that creates additional steps or work on the Claims Adjustor and suggest an alternative solution.
- Processes claims in accordance with established policies and procedures, contacting providers as needed, completing tasks under moderate supervision. Responsible for meeting the production and quality goals determined by the department leadership.
- Increased responsibilities, which may include assisting and mentoring less experienced team members, participating in various initiatives or projects within the Claims Delivery Team, documenting processes, performing advanced tasks, supporting high-dollar reviews, and overpayments/refunds.

You should have:

- Prior experience with a highly automated and integrated claims processing system.
- Experience working with HealthRules Payer preferred
- Knowledgeable about healthcare claims, medical coding, and rules applicable to Benefit Plans.
- Strong critical thinking skills and willingness to make independent decisions with little supervision.
- Excellent oral and written communication skills.
- Proven ability to work in a fast-paced environment, managing multiple issues with pressure of production schedules and deadlines.
- Proven ability to work independently for majority of day.
- Proficiency in Microsoft Office applications and other web-based software applications.
- Ability to learn new proprietary computer systems.
- High School diploma or GED required

Location:

- Remote
- Must be available during standard working hours and willing to work overtime as business needs require.

Note: A knowledge assessment may be required during the interview process

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. [centivo.com/our-team](https://centivo.com/our-team/)

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