Claims Configuration Program Manager

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role:
 

At Devoted, we understand that building trust hinges on our ability to pay claims accurately and on time, while maintaining the flexibility to adapt payment models as needed. Our Configuration Operations team manages claims system logic, provider fee schedules, and benefit configuration functions to ensure industry-leading claims payment accuracy and provider satisfaction. Devoted Health has developed a proprietary technology platform to support these objectives. The Claims Configuration Program Manager is responsible for overseeing all aspects of health plan benefit and fee schedule setup, analysis, mapping, testing, troubleshooting, and implementation. This role ensures the successful and accurate configuration of member cost share, benefit limitations, and provider payment information. The ideal candidate will act as a liaison across all departments regarding benefit and provider contract interpretation issues, ensuring seamless operations and effective communication.

Your Responsibilities and Impact will include: 

• Manage all aspects (interpretation, analysis, implementation and audit) of claims configuration including but not limited to benefits, contracts, devoted denial library

• Responsible for the daily oversight of our offshore partnership for Claims Configuration functions

• Preparing, completing, and monitoring benefit and fee schedule configuration for annual 1/1 readiness

• Manage and report on configuration program performance

• Manage the entire benefit category to the BID application process in coordination with cross functional teams

• Identify and implement creative process improvement (must be excited to roll up your sleeves and make things better!)

Required skills and experience: 

• 3 - 5 years experience processing claims within a Managed Care Organization, preferable Medicare Advantage 

• In-depth knowledge of health insurance claims processing, regulations, and compliance requirements. Ability to research and understand Medicare regulations

• Detailed-oriented with strong analytical and problem-solving skills, with proficiency in data analytics tools

• Strong leadership qualities to serve as a subject matter expert and guide others in benefit configuration and operations. Ability to collaborate effectively with cross-functional teams to achieve common goals

• Strong written, verbal, and interpersonal communication skills

Desired skills and experience: 

• Proven track record of success in managing benefit operations, technical needs, and cross-functional projects

• Certified professional coder (CPC) is a plus

Salary Range: $76,000 - $110,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• 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....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.