Claims Operations Manager - Refund Management

Devoted Health • Waltham, MA

1d • $73,000 - $125,000 • Remote

About The Position

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.

Requirements

• 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.
• Bachelor’s degree required, or equivalent experience in a high-growth or regulated environment.

Nice To Haves

• Background in healthcare technology, management consulting, or tech-ops where you thrived by delivering results in ambiguous environments.
• Success in becoming an SME in complex tools or regulatory frameworks to drive better business outcomes.
• Experience building collaborative, performance-driven relationships with cross-functional partners and offshore teams.

Responsibilities

• 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.
• 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.
• 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.
• Build and manage BI dashboards to track recovery trends. Identify deviations in performance and take immediate corrective action to keep the system on track.
• 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.
• Act as the primary liaison between Payment Integrity, Finance, and Product to close feedback loops on overpayment root causes, preventing leakage before it starts.

Benefits

• 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....

What This Job Offers

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