Senior Manager, Claims Adjudication & Automation (Remote)

Devoted Health; Oregon; Hybrid; USD 111,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Generous paid time off

Stock options

Bonus eligibility

Parental leave

401K program

Job summary

Devoted Health is seeking a Senior Manager, Claims Adjudication Logic to own the end-to-end rules that decide auto-adjudication, manual review, and EOB/EOP communications. You will partner with engineering and operations to ensure accurate, timely payments.

You will drive KPIs, governance, and root-cause analysis across claims, contracts, and remittance, shaping a scalable, cost-effective claims platform in a fast-paced, data-driven environment.

Qualifications

• 6+ years in business operations or operational leadership.
• Ability to navigate complex claims system logic.
• Excellent communication to technical and non-technical audiences.
• Proven track record of delivering measurable operational results.
• Experience building and using KPIs on large data sets.

Responsibilities

• Own auto-adjudication strategy and improve flags and routing.
• Serve as expert on contract group matching and provider contract relationships.
• Own EOBs and EOPs logic to accurately reflect outcomes.
• Support remittance outputs and 835/ERA resolution.
• Lead root cause analysis and implement sustainable fixes.
• Develop governance framework with audits and KPIs.
• Recommend proactive optimizations addressing regulatory changes.

Skills

Operational leadership

Claims adjudication knowledge

Analytical skills

KPI development

Cross-functional collaboration

Communication skills

Job description

Devoted Health is seeking a Senior Manager, Claims Adjudication Logic to own the end-to-end rules that decide auto-adjudication, manual review, and EOB/EOP communications. You will partner with engineering and operations to ensure accurate, timely payments.

You will drive KPIs, governance, and root-cause analysis across claims, contracts, and remittance, shaping a scalable, cost-effective claims platform in a fast-paced, data-driven environment.