Devoted Health: Claims Auditor
221 Crescent St., #202
Waltham, MA 02453

A bit about us:

Were on a mission to change healthcare how its paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.

Thats why were gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company one that combines compassion, health insurance, clinical care, and technology seamlessly.

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

This is a business operations role validating the accuracy of manually and automatically processed claims. This is not a technical/Systems QA role. At Devoted, we know that one of the most important ways we will build trust is by ensuring we can pay claims accurately and on time, while providing the strategic flexibility to change payment models. Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. The QA Analyst role is part of the Claims Operations team at Devoted and is responsible for validating claim adjudications as well as contract and benefit configurations relative to claims. Devoted Health has built their core technology platform from the ground up and the Claims QA Analyst will be an important asset to improve efficiencies and operations. The successful candidate will be a QA claims

Responsibilities will include:

  • Execute audits of claims processed via automation, internal claims examiners, off-shore claim examiners and delegated entities.
  • Perform an appropriate number of audits on a timely basis,
  • Be a thought partner in the development of the quality assurance vision, metrics, and operations
  • Identify and implement creative process improvement to our audit program (must be excited to roll up your sleeves and make things better!)
  • Perform concurrent, retrospective and preventive review of claims processed
  • Handle responses/appeals to audit findings
  • Develop expertise in all areas of Devoted Healths claims operation
  • Understand and adhere to complex regulations and developing policies and procedures
  • Work ad hoc projects for claims and audit operations as needed
  • Assist in the review and maintenance of auditing guidelines, including the audit tracking database and make recommendations to increase the accuracy of claims processed
  • Log, track, and report all audit and productivity results and provide information as needed.
  • Recommend areas in need of additional training and/or close oversight based on trending and analysis of audit results.
  • Handle urgent and/or sensitive issues
  • Maintain working knowledge of policies and procedures for standard work processes in the Claims Department.
  • Process claims on an occasional basis to maintain skills and support the team
  • Perform other duties as assigned

Attributes to success:

  • A true operator who will roll up your sleeves and do whatever it takes to get the job done
  • You have a bias towards action and execution, and a track record to support your ability to get things done
  • Clear head for process and procedures
  • You are passionate about process improvement and efficiency, and have an ability to predict and prevent roadblocks
  • You have the stamina and mindset for tackling challenging problems
  • Experience working with complex data and implementing systems and workflows
  • A creative thinker with a can-do attitude
  • Strong communicator who can work with cross-functional stakeholders and drive alignment

Desired skills and experience:

  • 3+ years in health plan claims operations (Medicare preferred)
  • Healthcare experience at a payer working in claims and/or audit operations
  • Coding certification(s) a plus
  • Track record of successfully developing and implementing systems, processes and setting and achieving targets
  • Ability to multitask
  • Good time management skills
  • Ability to succeed in a fast pace environment
  • Ability to work with data sets/reports in regards to downloading and manipulating data
  • Proficiency in Excel and/or Google sheets
  • Proficiency in Word or Google docs
  • Ability to efficiently communicate and have a good disposition with others regarding findings and process improvements

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!

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 Devoteds 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.