Claims Operations Manager - Refund Management

Devoted Health, Inc.

Job Overview

Location

Remote USA

Job Type

Full-time

Full Job Description

📋 Description

• The Claims Operations Manager for Refund Management leads the end-to-end modernization of Devoted Health’s provider refund ecosystem, transforming manual, error-prone processes into automated, audit-ready systems that ensure 100% accuracy and regulatory compliance in recovering overpayments.
• Day to day, the role involves designing and deploying the future state of the refund processing engine using AI, automation, and data platforms; owning the full refund check lifecycle from recovery to recoupment; building and managing BI dashboards to track performance and detect deviations; leading monthly audits for compliance with CMS timelines; and serving as the primary liaison between Payment Integrity, Finance, and Product to prevent leakage by closing feedback loops on overpayment root causes.
• Devoted Health is a fast-growing healthcare company founded in 2017, dedicated to improving the health and well-being of older Americans by integrating compassion, clinical care, insurance, service, and technology into a seamless, all-in-one healthcare experience. The company values diversity, collaboration, and innovation, and is committed to building a workforce that treats every member like family.
• In this role, the individual will develop deep expertise in healthcare payment integrity, gain mastery over complex data and automation tools, drive measurable impact on financial recovery and compliance, and grow into a strategic operations leader capable of scaling high-stakes systems in a regulated environment.

🎯 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

🏖️ 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
• Parental leave program
• 401K program

Skills & Technologies

Remote

$73k-125k

Degree Required

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Devoted Health, Inc.

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About Devoted Health, Inc.

Devoted Health, Inc. operates as a Medicare Advantage health plan provider, offering comprehensive coverage, personalized care navigation, and integrated technology to seniors across the United States. The company combines clinical expertise, data analytics, and member support services to coordinate physician visits, prescription management, and preventive care, aiming to improve health outcomes and reduce unnecessary costs for its members.

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