Senior Manager, Claims Adjudication Strategy

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

Avantages offerts par ce poste

Health, dental and vision plan

Generous paid time off

$100 monthly stipend for mobile/intern

Stock options for all employees

Bonus eligibility for most roles

Parental leave program

401K program

Résumé du poste

Devoted Health is seeking a Senior Manager, Claims Adjudication Logic to own the end-to-end rules governing auto-adjudication, provider-contract matching, and the communications that accompany claim outcomes. The role combines deep claims expertise with leadership to drive scalable, accurate processing.

This leadership position requires 6+ years in operations, strong analytical skills, and the ability to partner with engineering and provider operations to improve accuracy, reduce errors, and

Qualifications

• 6+ years in business operations or operational leadership.
• Ability to dive deep into complex claims system logic to understand how things work.
• Excellent communication skills for technical and non-technical audiences.
• Proven track record of driving meaningful change with measurable results in fast-paced settings.
• Strong analytical skills; experience building KPIs and diagnosing outcomes from large datasets.
• Ability to prioritize and manage multiple initiatives in a metrics-driven environment.

Responsabilités

• Own auto-adjudication strategy and performance as a core metric.
• Serve as expert for contract group matching between claims and provider contracts.
• Own EOB/EOP logic to accurately reflect outcomes and compliant communications.
• Support remittance outputs and 835/ERA processing with engineering and providers.
• Lead root-cause analysis of adjudication, matching, and communication errors.
• Establish governance with audits, validation testing, KPIs, and leadership reporting.
• Identify regulatory changes and new structures to reduce manual touch and risk.

Connaissances

Operational leadership

Complex claims logic

Communication skills

Process improvement

KPIs & analytics

Data analysis

Multi-tasking in fast-paced envs

Description du poste

Devoted Health is seeking a Senior Manager, Claims Adjudication Logic to own the end-to-end rules governing auto-adjudication, provider-contract matching, and the communications that accompany claim outcomes. The role combines deep claims expertise with leadership to drive scalable, accurate processing.

This leadership position requires 6+ years in operations, strong analytical skills, and the ability to partner with engineering and provider operations to improve accuracy, reduce errors, and