Payment Integrity Program Development Senior Manager

At Devoted, our mission is to build trust with our providers and members by ensuring claims are paid accurately and on time with transparent policies. Our Payment Integrity Concept Development Department is at the forefront of this effort, ensuring provider claims are paid correctly, free of errors, and aligned with contractual terms.
As our Payment Integrity Program Development Senior Manager, you will serve as a senior payment integrity subject matter expert operating in a high-autonomy, outcomes-driven role. You will help manage and optimize our portfolio of internal and vendor-supported payment integrity edits and audits, ensuring programs operate accurately, efficiently, and effectively.
Working collaboratively with Concept Development leaders and operational partners, you will oversee complex initiatives across implementation, validation, performance monitoring, maintenance, and issue resolution. You will combine claims and reimbursement expertise, analytical judgment, and operational insight to identify problems, develop practical solutions, and improve portfolio performance.
You will contribute to improvements in savings realization, operational efficiency, turnaround times, and provider experience while helping build scalable processes and capabilities.
Program Operations & Portfolio Management:

Manage assigned internal and vendor-supported payment integrity programs across implementation, monitoring, maintenance, and ongoing operational support. Evaluate program performance, including savings, hit rates, yield, turnaround times, and provider impacts. Identify trends, emerging risks, and opportunities for improvement.
Complex Root Cause Analysis & Remediation:

Independently investigate complex claims, configuration, and operational issues. Concept Implementation & Validation:

Partner with clinical, coding, and reimbursement SMEs to translate concept logic into clear implementation requirements. Collaborate with Engineering, Product, Data Science, and operational teams to support configuration, testing, deployment, and troubleshooting.
Maintenance, Monitoring & Compliance:

Coordinate portfolio maintenance, backsweeps, performance monitoring, regulatory updates, and compliance-related activities. Program & Process Improvement:

Identify recurring inefficiencies, capacity constraints, and operational risks. Data-Driven Decision-Making:

Use claims information, operational metrics, analytical tools, and performance trends to investigate issues, evaluate opportunities, and inform recommendations.
Develop a clear point of view, constructively challenge assumptions, and bring together stakeholders across Payment Integrity, Claims, Compliance, Engineering, Product, and Data Science to achieve measurable outcomes.
Project Management & Operational Scalability:

Independently lead complex, multi-phase initiatives, manage competing priorities and dependencies, and strengthen repeatable processes, knowledge sharing, and cross-coverage.
Bachelors degree and a minimum of 6 years of relevant professional experience within a health plan, payment integrity vendor, healthcare revenue cycle environment, or related healthcare setting.
Strong expertise in healthcare claims, payment integrity, claims editing, reimbursement, or related healthcare payment operations.
Demonstrated experience implementing, validating, maintaining, or optimizing payment integrity edits, audits, claims logic, or comparable healthcare operational programs.
Demonstrated ability to independently investigate complex claims or operational issues, perform root cause analysis, and translate findings into actionable solutions.
Strong analytical literacy, including the ability to interpret claims data, operational metrics, technical findings, and performance trends.
Strong independent judgment and ability to develop recommendations where data, policy, or operational signals may be incomplete or ambiguous.
Experience working with Engineering, Product, or technical configuration teams to implement and troubleshoot claims editing logic.
Familiarity with CMS guidance, NCCI frameworks, reimbursement policies, coding requirements, and healthcare claims adjudication.
Experience managing vendor-supported programs, validation operations, maintenance processes, or operational performance improvement.
Experience using SQL, AI-enabled analytical tools, automation, or other technology to improve payment integrity workflows and 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 value diversity and collaboration. 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.