Claims Operations Manager – Refund Management

🕒 May 20

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• 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....