Claims Operations Manager – Refund Management
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Job Description
Claims Operations Manager leading modernization of the provider refund ecosystem at Devoted Health. Focused on compliance, operational efficiency, and performance governance with cross-functional collaboration.
Responsibilities:
- Lead the end-to-end modernization of the provider refund ecosystem.
- Design and deploy the 'future state' of our refund processing engine, leveraging automation to eliminate manual touchpoints.
- Act as a hands-on operator by taking our internal toolkit—including AI, automation, and data platforms—and deploying them to hit specific recovery outcomes and performance targets.
- Define and own the 'Source of Truth' for program health.
- Build and manage BI dashboards to track recovery trends.
- Own the integrity of the program by building processes that ensure 100% compliance with CMS regulatory timelines and internal standards.
- Act as the primary liaison between Payment Integrity, Finance, and Product to close feedback loops on overpayment root causes, preventing leakage before it starts.
Requirements:
- Bachelor’s degree required, or equivalent experience in a high-growth or regulated environment.
- Proven ability to use complex data sets to drive performance and influence organizational outcomes.
- Proficiency with BI platforms (e.g., Snowflake, Looker, Tableau) and a track record of using LLMs or automation to solve business problems.
- Ability to translate complex technical or financial concepts into actionable plans for any audience.
- An elite eye for detail with the ability to pivot between tactical 'in the weeds' tasks and high-level goal alignment.
- Background in healthcare technology, management consulting, or tech-ops where you thrived by delivering results in ambiguous environments.
- Success in becoming an SME in complex tools or regulatory frameworks to drive better business outcomes.
- Experience building collaborative, performance-driven relationships with cross-functional partners and offshore teams.
Benefits:
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
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