• Own the day-to-day operational performance of the claims department, including direct oversight of Claims Managers, Supervisors, SMEs, and Sr. Examiners • Support the strategy and execution of a roadmap to drive auto-adjudication rates • Establish, monitor, and enforce inventory management standards and workflows to ensure claims are processed within defined SLAs across all claim types and funding arrangements • Establish and track key metrics related to claims administration including payment accuracy; use data to set targets and drive continuous improvement • Create and execute work plans to reduce and sustain optimal inventory levels, including resource planning, overtime management, and capacity forecasting • Develop and own the claims department's client experience strategy, ensuring that operational execution consistently reflects Centivo's service commitments and differentiators • Establish feedback loops with client-facing teams to identify recurring claims impacting client satisfaction and translate findings into operational improvements • Serve as the claims operational owner of the system transformation from Javelina to HRP, partnering with Technology, Implementation, and Product teams to ensure a successful transition • Ensure claims processing continuity and quality throughout all phases of the transformation, with minimal disruption to SLAs, client commitments, and member experience • Partner with Quality and Training teams to design and maintain a curriculum that ensures consistent application of benefit plan knowledge, adjudication standards, and compliance requirements across all claims staff • Establish proficiency standards and competency checkpoints for all claims roles; use quality audit data and performance metrics to identify training gaps and adjust programs accordingly • Own the prioritization of claims projects and client needs, balancing competing demands across operational improvement initiatives, system transformation workstreams, and time-sensitive client escalations; communicate prioritization decisions clearly to leadership and cross-functional partners to ensure alignment and appropriate resource allocation • Represent the claims organization in cross-functional meetings, vendor discussions, client calls, and provider engagements, serving as the operational authority for claims-related topics and ensuring that commitments made externally are realistic, documented, and handed off effectively to the appropriate internal and external stakeholders • Lead a structured root cause analysis (RCA) program to identify, categorize, and resolve the underlying drivers of claims errors, including configuration issues, examiner knowledge gaps, system limitations, and process breakdowns • Partner with Quality, Configuration, and Product teams to close the loop on identified error trends, ensuring fixes are implemented, validated, and sustained over time • Drive continuous improvement in claims processing workflows, identifying manual touchpoints, redundant steps, and pend patterns that create friction and delay; redesign processes to reduce waste and improve throughput • Identify opportunities for process automation, workflow optimization, and technology leverage to improve scale and reduce unit cost in claims operations • Collaborate with Plan Configuration, Stop Loss, Quality, Provider Operations, and Member Operations teams to resolve cross-functional dependencies and drive aligned outcomes • Translate VP-level operational strategy into department-level goals, plans, and priorities; cascade direction clearly to managers and hold teams accountable for execution • Directly manage Claims Managers and provide coaching, performance feedback, and development support aligned to Centivo's leadership behaviors • Set clear performance expectations, establish measurable goals aligned to organizational priorities, and hold direct reports accountable for results • Model and reinforce Centivo's leadership skills and behaviors — Communicate, Clarify, Coach, and Connect — through daily interactions and team management practices • Foster a culture of accountability, execution rigor, and psychological safety within the claims department