Note: The job is a remote job and is open to candidates in USA. Devoted Health Services, Inc. is hiring a Claims Compliance Program Manager to oversee claims compliance activities, operational quality initiatives, and audit readiness. The role monitors performance and compliance gaps, coordinates audits and issue remediation, and supports quality assurance and process improvements across claims operations, including Medicare Advantage and Medicaid.
Responsibilities
- Monitor claims compliance activities, KPIs, and reports to identify trends, risks, operational gaps, and areas for improvement
- Coordinate and document internal, financial, and regulatory audits
- Analyze claims data to identify discrepancies and recurring issues
- Track compliance issues, deliverables, Jira tasks, and audit findings, collaborating cross-functionally to ensure timely remediation
- Support quality assurance operations, including audit workflows, operational reporting, and data validation
- Develop and update policies, procedures, and related compliance materials
- Escalate compliance concerns and control deficiencies to management
- Participate in risk assessments to strengthen internal controls
- Collaborate across Claims, Payment Integrity, and Compliance teams to investigate issues
- Evaluate workflow gaps and recommend practical solutions to mitigate risks
- Support the implementation and oversight of corrective action plans
- Identify opportunities to improve the efficiency, accuracy, and consistency of assigned compliance activities
- Assist with AI initiatives and automation projects in claims compliance operations
Skills
- Proven ability to manage multiple priorities, support operational monitoring activities, and ensure timely tracking of compliance deliverables and issue resolution
- Strong interpersonal and verbal communication skills to effectively collaborate across teams and engage with cross-functional stakeholders on audit and compliance findings
- Proficient in drafting clear, precise, and structured compliance reports, summaries, and official audit documentation
- Experience in developing, updating, and standardizing standard operating procedures (SOPs), policies, and workflow documentation
- Bachelor's degree required, or equivalent work experience
- Experience in healthcare, healthcare technology, or tech operations, preferred
- Experience with healthcare operations, claims adjudication, or regulatory compliance requirements, preferred
- Proven ability to thrive in a fast-paced startup environment
- Capacity for high throughput, while working both autonomously and collaboratively with others
- Track record of success becoming an expert with a tool or system that was unfamiliar to you
- Comfort using data and reporting platforms to drive operational insights and track performance
Benefits
- For full-time employees only: employer-sponsored health, dental and vision plan with low or no premium
- For full-time employees only: generous paid time off
- For full-time employees only: $100 monthly mobile or internet stipend
- For full-time employees only: stock options for all employees
- For full-time employees only: bonus eligibility for all roles excluding Director and above
- For full-time employees only: commission eligibility for Sales roles
- For full-time employees only: parental leave program
- For full-time employees only: 401K program
- Remote within the United States
Company Overview