Claims Compliance Program Manager

The Claims Compliance Program Manager will oversee and support our claims compliance activities, operational quality initiatives, and audit readiness. Reporting to the Claims Compliance Senior Program Manager, you will monitor key performance indicators, partner cross-functionally to address compliance gaps, reinforce operational and regulatory standards across claims operations (including Medicare Advantage and Medicaid), and drive project tracking and issue resolution.
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.
Organization Skills:

Proven ability to manage multiple priorities, support operational monitoring activities, and ensure timely tracking of compliance deliverables and issue resolution.
Communication Skills:

Strong interpersonal and verbal communication skills to effectively collaborate across teams and engage with cross-functional stakeholders on audit and compliance findings.
Writing Skills:

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.
Bachelors 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
Comfort using data and reporting platforms to drive operational insights and track performance

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. Employer sponsored health, dental and vision plan with low or no premium
~ Stock options for all employees
~ Bonus eligibility for all roles excluding Director and above; Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where were going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
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. 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.