---
title: 'Director Claims Management Ancillary Services (CMAS) at Centivo'
canonical: 'https://feeny.ai/job/director-claims-management-ancillary-services-cmas-centivo-remote-w4tr7w1fb7ej'
type: 'job'
last_seen: '2026-09-08'
---

# Director Claims Management Ancillary Services (CMAS) at Centivo

- **Company:** Centivo
- **Location:** Remote
- **Compensation:** $135k–$145k
- **Employment:** full-time
- **Work type:** remote
- **Posted:** 2026-08-25
- **Last confirmed live:** 2026-09-08
- **Apply:** https://jobs.ashbyhq.com/centivo/59fcd2f1-4d90-435a-a721-d01796848b23

## 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.

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 plan document output
- Serve as the escalation point for complex plan document issues, client-specific plan design questions, and stop loss carrier document submissions
- Champion adoption and continuous improvement of plan document tools and technology (e.g., PDM) to improve accuracy, throughput, and client experience

CMAS Operational Leadership

- Own end-to-end performance of CMAS functions—claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA)—ensuring accuracy, compliance, and adherence to service-level agreements
- Establish and monitor operational and quality KPIs across CMAS and Plan Documents, using data to identify trends and risks and to report performance to department leadership
- Direct workforce and capacity planning across both functions, including inventory management, resource allocation, and overtime oversight, to balance cost efficiency with service performance
- Drive process improvement, workflow standardization, and automation and AI-enabled enhancements across CMAS and Plan Document workflows
- Oversee development and enforcement of policies and procedures to ensure consistent administration of CMAS and Plan Document standards

People Leadership & Cross-Functional Collaboration

- Directly manage the Plan Documents Manager and CMAS Manager, providing coaching, performance feedback, and development aligned to Centivo's leadership behaviors
- Set clear performance expectations and measurable goals for both teams, aligned to organizational priorities, and hold managers accountable for results
- Foster a culture of accountability, collaboration, and engagement across the CMAS and Plan Documents teams, involving staff in problem-solving and solution design
- Represent CMAS and Plan Documents in cross-functional meetings, client calls, and discussions with brokers, agents, TPAs, and stop loss carriers, serving as the operational authority for these functions
- Model and reinforce Centivo's leadership behaviors — Communicate, Clarify, Coach, Connect, and Customize — through daily interactions and team management practices
- Perform other duties as deemed essential and necessary

Qualifications:

Required Skills and Abilities:

- 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations at a TPA, health plan, or benefits consulting firm
- 5 years of leadership experience managing managers, supervisors, or teams, including experience overseeing plan document, compliance, or claims ancillary functions
- Deep knowledge of ERISA, the Internal Revenue Code, HIPAA, MSP, COBRA, the ACA, and WHCRA as they apply to employer-sponsored welfare benefit plans
- Demonstrated experience overseeing plan document drafting and management (SBCs, SPDs, SMMs) in a self-funded or TPA environment
- Demonstrated experience overseeing claims audit, appeals, recoveries, subrogation, NSA, or quality assurance functions in a regulated environment
- Strong data literacy; ability to interpret operational and quality metrics and translate findings into action plans
- Experience partnering with Legal, Compliance, Configuration, and Client Success teams to resolve cross-functional dependencies
- Bachelor's degree required; paralegal certification or advanced degree in a relevant discipline preferred

Preferred Qualifications:

- Employee benefits paralegal background or equivalent experience in plan document creation and management
- Experience with Phia Group's PDM portal or similar plan document management systems
- Experience with claims adjudication systems (e.g., Javelina, Health Rules Payer, or similar)
- Experience leading or contributing to a claims system implementation or transformation
- Experience in client-facing roles or working closely with account management teams on claims or plan document issues

Work Location:

This position is remote.

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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