Claims Configuration Senior Manager

Job Description A bit about this role: At Devoted, we understand that building trust hinges on our ability to pay claims accurately and on time, and to clearly communicate those outcomes to our members and providers. The Senior Manager, Claims Adjudication Logic will be the subject matter expert on how our claims move through the system: the rules that determine whether a claim auto-adjudicates or pends for manual review, how claims are matched to the correct provider contract, and how outcomes are communicated through Explanations of Benefits (EOBs), Explanations of Payment (EOPs), and remittance advice. This person will own the accuracy, integrity, and strategic direction of our claims back-end logic. The ideal candidate is a curious, detail-oriented problem solver who enjoys tracing a claim from intake to payment, takes ownership of issues from discovery to resolution, and thinks strategically about how to build a more accurate, automated, scalable, and cost-effective claims operation. Your Responsibilities and Impact will include: Auto-Adjudication Strategy & Performance: Own our auto-adjudication rate as a core operational metric. Develop a deep understanding of the flags and pend reasons that route claims to manual review. Evaluate each for business value, accuracy, and operational cost. Partner with engineering to retire, refine, or automate flags that no longer serve their purpose, and design new ones where risk warrants human review. Contract Group Matching: Serv