Director, Claims Operations

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role: 

• At Devoted, we know that one of the most important ways we build trust with our network of providers and members is to pay claims accurately, on time, and with transparency. We are seeking a seasoned, strategic, and operationally excellent Claims Operations Director to lead our claims organization — spanning a small onshore team and a large offshore operation.

• This role is critical to delivering our service promise to members and providers. The Director will oversee all aspects of claims adjudication and payment operations, vendor management, quality improvement, and innovation initiatives. They will champion the use of technology, including AI and automation, to drive continuous improvement, operational rigor, and an outstanding service experience.

• We are looking for a hands-on, metrics-driven leader with deep healthcare claims expertise and a passion for building great teams and scalable solutions.

Your Responsibilities and Impact will include: 

• Lead and oversee claims operations across a small onshore team and a large offshore organization, ensuring high-quality, timely, and compliant claims processing.

• Serve as the senior subject matter expert in healthcare claims, applying deep industry knowledge to drive operational excellence, compliance, and innovation.

• Manage vendor and offshore partnerships to ensure performance standards, contract requirements, and member/provider experience expectations are consistently met or exceeded.

• Achieve and maintain critical enterprise goals, including claims timeliness, member reimbursements, appeals outcomes, and medical cost management targets.

• Develop and mentor a high-performing, accountable team, fostering a culture of professional growth, operational rigor, and customer-centered service.

• Collaborate cross-functionally with Technology, Product, Clinical Services, Compliance, and other teams to design, implement, and optimize end-to-end operational solutions.

• Identify and drive process improvements leveraging data insights, automation, and AI-powered tools to continuously improve efficiency, accuracy, and service quality.

Required skills and experience:

• Bachelor’s degree and a minimum of 8 years of healthcare operations leadership experience.

• Deep expertise in healthcare claims operations, including claims adjudication, provider reimbursements, appeals, disputes, and CMS regulations.

• Proven success leading and scaling both onshore teams and large offshore/vendor operations.

• Demonstrated ability to deliver outstanding operational results while maintaining strict compliance, quality, and service standards.

• Strong experience leveraging automation, AI, and analytics to optimize workflows, drive efficiencies, and enhance the claims experience.

• Strategic thinker with strong financial acumen, capable of managing budgets and operational costs while improving service outcomes.

• Outstanding interpersonal, written, and verbal communication skills — able to build trust and alignment across technical and non-technical stakeholders.

• Ability to travel internationally up to 10% of the time to engage with offshore teams and partners.

Desired skills and experience:

• Master’s degree in Business, Healthcare Administration, or a related field.

• Experience in Lean Six Sigma or other continuous improvement methodologies.

• Proficiency with SQL and advanced Excel/Google Sheets for operational data analysis and reporting.

• Strong knowledge of healthcare claims technology platforms and payment integrity tools.

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Salary range: $164,000 - $220,000 /year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• 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....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

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.