Claims Operations Manager - Refund Management

Job Description

A Bit About This Role We are on a journey to modernize and transform our entire claims system end-to-end. As the Claims Operations Manager for Refund Checks, you will lead the transformation of how we recover, reconcile, and manage provider overpayments. We are looking for a high-impact operator—someone who doesn’t just suggest ideas but owns the high-stakes operational ecosystem. You will be responsible for the health, scalability, and performance of our refund engine, ensuring every dollar recovered is handled with 100% accuracy and strict regulatory compliance. You are a builder who takes messy, manual workflows and transforms them into automated, high-performing, and audit-ready engines. Your Responsibilities and Impact System Transformation: 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. Operational Deployment: 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. Outcome Ownership: Define and own the "Source of Truth" for program health. You are responsible for the entire refund check lifecycle, moving beyond reporting to ensure recoupment targets are met and "leakage" is eliminated. Performance Governance: Build and manage BI dashboards to track recovery trends. Identify deviations in performance and take immediate corrective action to keep the system on track. Compliance Engineering: Own the integrity of the program by building processes that ensure 100% compliance with CMS regulatory timelines and internal standards. Lead the monthly audit process to ensure a state of constant audit-readiness. Cross-Functional Execution: Act as the primary liaison between Payment Integrity, Finance, and Product to close feedback loops on overpayment root causes, preventing leakage before it starts. Required Skills and Experience The Operator Mindset: You are a builder who focuses on execution. You define a complex endpoint and use your toolkit to get there, using quantifiable mile markers to track progress. Analytical Horsepower: Proven ability to use complex data sets to drive performance and influence organizational outcomes. Technical Deployment: Proficiency with BI platforms (e.g., Snowflake, Looker, Tableau) and a track record of using LLMs or automation to solve business problems. Conversational Agility: Ability to translate complex technical or financial concepts into actionable plans for any audience. Extreme Organization: An elite eye for detail with the ability to pivot between tactical "in the weeds" tasks and high-level goal alignment. Educational Foundation: Bachelor’s degree required, or equivalent experience in a high-growth or regulated environment. Desired Skills and Experience High-Growth Operations: Background in healthcare technology, management consulting, or tech-ops where you thrived by delivering results in ambiguous environments. Systems Expertise: Success in becoming an SME in complex tools or regulatory frameworks to drive better business outcomes. Relationship Management: Experience building collaborative, performance-driven relationships with cross-functional partners and offshore teams. #LI-Remote Salary range: $73,000-$125,000 / year The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. 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 will 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. 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! 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. Apply To This Job