Director, Claims Operations

Position Overview

• Location Type: Not Specified
• Job Type: Full time
• Salary: Not Specified

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. We are building a new kind of all-in-one healthcare company, integrating compassion, health insurance, clinical care, service, and technology to deliver a complete and integrated healthcare solution. Founded in 2017, Devoted Health serves members across the United States.

About the Role

Devoted Health is seeking a seasoned, strategic, and operationally excellent Claims Operations Director to lead its claims organization, which includes a small onshore team and a large offshore operation. This role is crucial for delivering on 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, championing the use of technology, including AI and automation, to drive continuous improvement and an outstanding service experience.

Responsibilities

• Lead and oversee claims operations across both onshore and offshore teams, ensuring high-quality, timely, and compliant claims processing.
• Serve as the senior subject matter expert in healthcare claims, driving operational excellence, compliance, and innovation.
• Manage vendor and offshore partnerships to ensure performance standards, contract requirements, and member/provider experience expectations are 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 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 operational solutions.
• Identify and drive process improvements leveraging data insights, automation, and AI-powered tools to enhance efficiency, accuracy, and service quality.

Requirements

• 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.
• Ability to travel internationally up to 10% of the time.

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.

Company Information

At Devoted Health, we are committed to caring for every person like family and improving the health and well-being of older Americans. We are a fast-growing company founded in 2017, serving members across the United States.