Payment Integrity Business Transformation Manager

United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates should have 5+ years of operations experience, preferably in a Medicare Advantage health plan or startup environment. A strong desire and ability to quickly learn Payment Integrity concepts and workflows are essential, along with experience influencing and driving change in a highly-matrixed organization. Experience with tech and data teams is a plus. Strong organizational skills, including prioritizing and managing multiple initiatives, are required, as is an analytic mindset and the ability to execute qualitative and quantitative analyses that drive impact. Exceptional communication and cross-functional collaboration skills are necessary, along with professionalism and comfort with ambiguity. The ideal candidate is a self-starter who enjoys solving complex operational problems, implementing new processes, and driving impact.

Responsibilities

The Payment Integrity Business Transformation Manager will ensure the successful execution of Payment Integrity programs and processes. This includes actively triaging, investigating, and resolving operational issues and escalations to ensure timely and accurate resolution. Responsibilities also involve identifying root cause drivers and implementing solutions to address issue recurrence and continuously improve processes. The manager will collaborate closely with technical, auditing, and business teams to address operational gaps and improve/scale workflows, support teams in learning new processes, and provide guidance. Analyzing performance data, providing insights, and driving action to address bottlenecks and improve productivity, accuracy, and compliance are also key duties.

Skills

Payment Integrity

Business Transformation

Operational Execution

Escalation Management

Problem-Solving

Process Implementation

Workflow Redesign

Issue Triage

Root Cause Analysis

Performance Analysis

Data Analysis

Communication

Cross-functional Collaboration

Organizational Skills

Prioritization

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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