Senior Claims Configuration Manager

Devoted Health

. Own the auto-adjudication rate as a core operational metric .

Posted 10/26/2026full-timeRemote • United StatesSenior💰 $110,500 - $150,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims processing and operational leadership, with a strong focus on improving adjudication outcomes and aligning provider contracts. Proficient in analyzing complex claims logic and driving sustainable operational improvements through collaboration with cross-functional teams.

Highest-signal resume keywords

Claims Processing ExpertiseOperational LeadershipAnalytical SkillsCommunication SkillsHealth Insurance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Logic AnalysisKPI DevelopmentRoot Cause AnalysisAdjudication WorkflowsPayment ReconciliationAutomationAI Tools ExperienceRegulatory ComplianceData AnalysisContract Management

Soft Skills

Exceptional CommunicationCuriosityAdaptabilityBias Toward ActionProblem-Solving

Tools & Technologies

Claims Systems835/ERA FilesWorkflow Design ToolsMetrics-Driven ToolsAutomation Tools

Industry Keywords

Medicare AdvantageProvider ContractingOperational RiskClaims AdjudicationPayment Errors

About the role

Key responsibilities & impact

Own the auto-adjudication rate as a core operational metric
Develop a deep understanding of flags and pend reasons routing claims to manual review
Evaluate flags for business value, accuracy, and operational cost
Partner with Engineering to retire, refine, or automate flags and design new ones where risk warrants human review
Serve as the go-to expert on matching claims to provider contracts and contract groups
Identify and resolve provider contract mismatches leading to incorrect payment
Partner with Provider Operations and Network to align contract intent with claims processing
Own logic generating member EOBs and provider EOPs
Ensure communications accurately reflect adjudication outcomes, member cost share, and denial or adjustment reasons
Ensure member-facing communications meet CMS requirements and provider-facing communications support payment reconciliation
Serve as subject matter expert on remittance outputs, including 835/ERA files and payment reconciliation
Support providers, Provider Services, and Engineering in resolving remit issues and drive root-cause fixes
Proactively identify adjudication, matching, and communication errors
Lead root cause analysis and drive sustainable fixes with Engineering, Claims Operations, and Network/Provider Operations
Establish and own claims logic performance measurement framework
Build audits, validation testing, KPIs, and reporting for payment outcomes
Recommend improvements addressing regulatory changes, new contract structures, and emerging technology to reduce manual work, payment errors, provider abrasion, and operational risk

Requirements

What you’ll need

6+ years of experience in business operations or operational leadership
Comfort with ambiguity and a willingness to dive deep complex claims system logic to fully understand how things work
Exceptional communication skills, with the ability to explain complex claims logic to both technical and non-technical audiences
Demonstrated success in driving meaningful change and measurable operational results in fast-paced environments, with a bias toward action and a focus on continuous improvement
Strong analytical skills, with experience building and developing KPIs, and the ability to work with large claims datasets to diagnose adjudication outcomes and quantify operational and financial impact
Thrives in a fast-paced, metrics-driven environment, with the ability to prioritize and manage multiple initiatives at once
Curiosity and hands-on experience with AI tools, automation, or LLM-based workflows in operational settings is highly desired
Knowledge of health insurance claims processing, particularly Medicare Advantage, including adjudication workflows, provider contracting, and regulatory and compliance requirements
Experience partnering with Engineering on rules-based systems, workflow design, or claims platform development

Benefits

Comp & perks

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