Claims Adjustor

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 will begin in October 2026 with specific dates to be announced soon.

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 ...