Remote Claims Compliance Manager

Devoted Health Services, Inc; Waltham (MA); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

Health plan

Generous PTO

Stock options

Bonus eligibility

Job summary

Devoted Health is seeking a Claims Compliance Program Manager to oversee and improve our claims compliance activities, audits, and operational quality initiatives. You will report to the Senior Program Manager and partner across Claims, Payment Integrity, and Compliance teams to remediate gaps and strengthen controls.

Responsibilities include monitoring KPIs, performing audits, analyzing data for discrepancies, and developing SOPs and compliance materials.

Qualifications

• Bachelors degree or equivalent work experience required.
• Strong organizational and multitasking abilities.
• Excellent writing for reports, summaries, and audit documentation.
• Experience drafting SOPs, policies and workflow documentation.
• Ability to collaborate across cross-functional teams.

Responsibilities

• Monitor claims compliance activities, KPIs, and reports to identify trends, risks, operational gaps.
• 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; drive remediation.
• Support QA operations, including audit workflows and data validation.
• Develop and update SOPs, policies, and related compliance materials.
• Escalate compliance concerns 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 risk-mitigating solutions.
• 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

Education

Bachelor's degree or equivalent work experience

Job description

Devoted Health is seeking a Claims Compliance Program Manager to oversee and improve our claims compliance activities, audits, and operational quality initiatives. You will report to the Senior Program Manager and partner across Claims, Payment Integrity, and Compliance teams to remediate gaps and strengthen controls.

Responsibilities include monitoring KPIs, performing audits, analyzing data for discrepancies, and developing SOPs and compliance materials.