Claims Compliance & Audit Program Manager

Devoted; United States; Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Health, dental and vision plan

Generous paid time off

$100 monthly stipend for mobile/intern

Stock options for all employees

Bonus eligibility for most roles

Parental leave

401K plan

More rewards

Job summary

Devoted Health is seeking a Claims Compliance Program Manager to oversee and support claims compliance, quality initiatives, and audit readiness. This role reports to the Claims Compliance Senior Program Manager and focuses on monitoring KPIs, addressing gaps, and driving remediation across Medicare Advantage and Medicaid claims operations.

The position involves risk assessment, policy development, and collaboration with Claims, Payment Integrity, and Compliance teams.

Qualifications

• Organization skills to manage multiple priorities and track compliance deliverables.
• Strong communication to collaborate across teams on audit findings.
• Proficiency in drafting clear, structured compliance reports and summaries.
• Experience creating, updating, and standardizing SOPs, policies, and workflow docs.
• Bachelor's degree or equivalent work experience is required.

Responsibilities

• Monitor compliance activities, KPIs, and reports to identify trends, risks, operational gaps, and areas for improvement.
• Coordinate and document internal, financial, and regulatory audits.
• Analyze claims data to identify discrepancies and recurring issues.
• Track compliance issues, deliverables, Jira tasks, and audit findings, ensuring timely remediation.
• Support quality assurance operations, including audit workflows, reporting, and data validation.
• Develop and update policies, procedures, and related compliance materials.
• Escalate compliance concerns and control deficiencies to management.
• Participate in risk assessments to strengthen internal controls.
• Collaborate across Claims, Payment Integrity, and Compliance teams to investigate issues.
• Evaluate workflow gaps and propose practical solutions to mitigate risks.
• Support implementation and oversight of corrective action plans.
• Identify opportunities to improve efficiency, accuracy, and consistency of compliance activities.
• Assist with AI initiatives and automation projects in claims compliance operations.

Skills

Organization skills

Communication skills

Writing skills

Process documentation

Bachelor's degree or equivalent

Education

Bachelor's degree

Job description

Devoted Health is seeking a Claims Compliance Program Manager to oversee and support claims compliance, quality initiatives, and audit readiness. This role reports to the Claims Compliance Senior Program Manager and focuses on monitoring KPIs, addressing gaps, and driving remediation across Medicare Advantage and Medicaid claims operations.

The position involves risk assessment, policy development, and collaboration with Claims, Payment Integrity, and Compliance teams.