Senior Payment Integrity Manager

Devoted Health • Waltham, MA

22h • Remote

About The Position

A bit about this role: At Devoted, we know that one of the most important ways we will build trust with our network of providers and members is to pay claims accurately and on time while having transparent payment policies. Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices. The Senior Manager, Payment Integrity is a senior operational leader responsible for overseeing the strategy, execution, and performance optimization of the organization's payment integrity programs. This role ensures that both prepayment and post payment audit functions are designed and delivered to achieve savings, reduce error rates, and align with regulatory requirements. The Senior Manager drives operational excellence, manages escalations, collaborates cross-functionally to improve end-to-end audit workflows, and provides guidance to internal teams and external partners.

Requirements

• Bachelor’s degree and 6+ years of professional experience in high-growth operations, strategy, or healthcare management
• Proven ability to drive alignment across departments (Operations, Product, Engineering) and manage up to senior leadership. You don't just follow a roadmap; you help build it
• An understanding of the US healthcare ecosystem. You understand how the "pipes" work, even if you aren't an expert in every niche billing code
• You are energized by ambiguity. You can build a process where one doesn't exist and pivot gracefully when company needs shift
• You are equally comfortable presenting a high-level strategy as you are rolling up your sleeves to execute the tactical daily work
• Ability to use the company’s vision and values as a North Star when making difficult operational trade-offs

Nice To Haves

• Proficiency with SQL
• Familiarity with agile methodologies or frameworks for managing complex, cross-functional initiatives

Responsibilities

• Lead and optimize the execution of enterprise payment integrity initiatives, with accountability for performance across prepay and postpay claims review programs.
• Translate organizational strategy into operational action plans, ensuring alignment with savings goals, audit integrity, and regulatory compliance.
• Partner with analytics, finance, compliance, and tech to identify new audit opportunities, improve processes, and develop scalable solutions.
• Oversee the health of audit pipelines by ensuring work inflow and outflow are properly forecasted, balanced, and executed.
• Monitor program KPIs such as savings, throughput, adjustment timeliness, and audit yield. Take corrective action when performance falls short.
• Use data to identify root causes of inefficiencies or payment errors and lead the development of solutions to reduce future risk.
• Serve as a senior escalation point for complex issues involving claims adjustments, provider disputes, and operational bottlenecks.
• Collaborate with departments such as Claims, Appeals, Provider Relations, and Medical Management to troubleshoot issues and implement improvements across the payment life cycle.

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

What This Job Offers

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