Claims Compliance Program Manager

Devoted Health • Waltham, MA

4d • $73,000 - $130,000 • Remote

About The Position

The Claims Compliance Program Manager oversees and supports claims compliance activities, operational quality initiatives, and audit readiness. Reporting to the Claims Compliance Senior Program Manager, this role monitors key performance indicators, partners cross-functionally to address compliance gaps, reinforces operational and regulatory standards across claims operations—including Medicare Advantage and Medicaid—and drives project tracking and issue resolution.

The role supports audit coordination, quality assurance workflows, claims data analysis, policy and procedure documentation, risk assessments, corrective action plans, and process improvements. It also assists with AI initiatives and automation projects in claims compliance operations.

Requirements

• 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 for collaborating across teams and engaging cross-functional stakeholders on audit and compliance findings.
• Proficiency in drafting clear, precise, and structured compliance reports, summaries, and official audit documentation.
• Experience developing, updating, and standardizing standard operating procedures (SOPs), policies, and workflow documentation.
• Bachelor's degree or equivalent work experience.

Nice To Haves

• Experience in healthcare, healthcare technology, or tech operations.
• Experience with healthcare operations, claims adjudication, or regulatory compliance requirements.
• Ability to thrive in a fast-paced startup environment.
• Capacity for high throughput while working autonomously and collaboratively.
• Track record of becoming an expert with an unfamiliar tool or system.
• Comfort using data and reporting platforms to drive operational insights and track performance.

Responsibilities

• Monitor claims compliance activities, KPIs, and reports to identify trends, risks, operational gaps, and improvement areas.
• 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, working cross-functionally to support 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 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.

Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for roles below Director level; commission eligibility for Sales roles.
• Parental leave program.
• 401K program.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager