Senior Manager, Claims Adjudication & Automation

Devoted Health; United States; Remote; USD 111,000 - 150,000; Full time

Benefits offered by this job

Employer sponsored health, dental and视

Vision plan

Generous paid time off

Stock options for all employees

Bonus eligibility for all roles

401K program

Job summary

Devoted Health is seeking a Senior Manager of Claims Adjudication Logic to own the backend rules that drive auto-adjudication, provider contract matching, and EOB/EOP communications. You will partner with Engineering and Claims Operations to improve accuracy, automation, and cost efficiency across the claims lifecycle.

The role emphasizes governance, KPI-driven optimization, and proactive regression prevention, with a focus on scalable, rules-based systems and regulatory alignment.

Qualifications

• 6+ years of experience in business operations or operational leadership.
• Ability to explain complex claims logic to both technical and non-technical audiences.
• Experience building KPIs and analyzing large claims datasets to quantify impact.

Responsibilities

• Own auto-adjudication strategy and performance as a core metric.
• Match claims to provider contracts and contract groups, resolve mismatches.
• Own EOB/EOP logic to reflect adjudication outcomes and cost sharing clearly.
• Lead remittance support, including 835/ERA files and reconciliations.
• Lead root-cause analysis and sustainable fixes with cross-functional partners.
• Establish governance with audits, KPIs, and reporting for payment outcomes.

Skills

Analytical skills

KPIs

Operations leadership

Communication

Problem solving

Data analysis

Tools

Claims system knowledge

Job description

Devoted Health is seeking a Senior Manager of Claims Adjudication Logic to own the backend rules that drive auto-adjudication, provider contract matching, and EOB/EOP communications. You will partner with Engineering and Claims Operations to improve accuracy, automation, and cost efficiency across the claims lifecycle.

The role emphasizes governance, KPI-driven optimization, and proactive regression prevention, with a focus on scalable, rules-based systems and regulatory alignment.