Remote Senior Manager, Claims Adjudication & Automation

Devoted Health Services; United States; À distance; USD 111 000 - 150 000; Plein temps

Résumé du poste

Devoted Health Services in the United States is seeking a Senior Manager, Claims Adjudication Logic to own and optimize back-end rules that drive auto-adjudication and manual review decisions. You will oversee EOBs/EOPs and remittance outputs, ensuring accurate, compliant, and timely payments.

The role requires deep claims system knowledge, strong analytics, and ability to partner with Engineering, Claims Operations, and Network/Provider Operations to reduce errors and costs.

Qualifications

• 6+ years of experience in business operations or operational leadership.
• Ability to dive deep into complex claims system logic.
• Exceptional communication skills for technical and non-technical audiences.
• Proven track record delivering measurable operational results in fast-paced environments.
• Strong analytical skills with KPI development and large dataset work.

Responsabilités

• Own auto-adjudication strategy and performance metrics.
• Match claims to provider contracts and contract groups; resolve mismatches.
• Own EOB/EOP logic to reflect adjudication outcomes.
• Support remittance outputs (835/ERA) and provider payment reconciliation.
• Lead root cause analysis for adjudication, matching, and communication errors.
• Establish governance framework with KPIs, audits, and reporting.
• Identify regulatory changes and propose automation to reduce manual touch.

Connaissances

Auto-adjudication

KPIs

Cross-functional leadership

Data analysis

Communication

Outils

835/ERA files

Description du poste

Devoted Health Services in the United States is seeking a Senior Manager, Claims Adjudication Logic to own and optimize back-end rules that drive auto-adjudication and manual review decisions. You will oversee EOBs/EOPs and remittance outputs, ensuring accurate, compliant, and timely payments.

The role requires deep claims system knowledge, strong analytics, and ability to partner with Engineering, Claims Operations, and Network/Provider Operations to reduce errors and costs.