Remote Claims Compliance & Audit Lead

Devoted Health; Oregon; Hybrid; USD 73,000 - 130,000; Full time

Benefits offered by this job

Health, dental and vision plan

Generous paid time off

$100 monthly mobile or internet stiped

Stock options for all employees

Bonus eligibility for all roles

Parental leave program

401K program

And more....

Job summary

Devoted Health is seeking a Claims Compliance Program Manager to oversee claims compliance, audits, and operational quality initiatives across Medicare Advantage and Medicaid. You will monitor KPIs, partner cross-functionally, and drive issue resolution.

Reporting to the Claims Compliance Senior Program Manager, you will coordinate internal audits, analyze data, track Jira tasks, and help develop policies and SOPs. This role emphasizes proactive risk mitigation in a fast-paced environment.

Qualifications

• Bachelor's degree or equivalent required; relevant work experience acceptable.
• Proven ability to manage multiple priorities and track compliance deliverables.
• Strong written communication for audits, reports, and summaries.
• Experience in SOPs, policies, and workflow documentation development.

Responsibilities

• Oversee claims compliance activities, KPIs, and reports to identify trends and gaps.
• Coordinate and document internal, financial, and regulatory audits.
• Analyze claims data to identify discrepancies and recurring issues.
• Track compliance issues, deliverables, and audit findings with cross-functional remediation.
• Assist with QA operations, audit workflows, and data validation.
• Develop and update SOPs and related policies.
• Escalate compliance concerns and control deficiencies to management.
• Collaborate across teams to investigate issues and strengthen internal controls.

Skills

Organization

Communication

Writing

Process documentation

Education

Bachelor's degree or equivalent

Tools

Jira

Job description

Devoted Health is seeking a Claims Compliance Program Manager to oversee claims compliance, audits, and operational quality initiatives across Medicare Advantage and Medicaid. You will monitor KPIs, partner cross-functionally, and drive issue resolution.

Reporting to the Claims Compliance Senior Program Manager, you will coordinate internal audits, analyze data, track Jira tasks, and help develop policies and SOPs. This role emphasizes proactive risk mitigation in a fast-paced environment.