A bit about us:

We’re on a mission to change healthcare — how it’s 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.

That’s why we’re 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.

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. Our Claims Operations team is responsible for managing claims processing and payment as well as contract and benefit configuration functions. Devoted is committed to building a team of people, effective processes and proprietary technology that delivers industry leading claims payment, accuracy and provider satisfaction. Devoted Health is building the core technology platform from the ground up. The Claims Auditor is responsible for performing reviews of claims adjudicated manually by Claims Specialists or automatically by the system. This position has the sole responsibility to ensure that each audit performed is of the highest quality. The Claims Auditor will review and summarize findings as well as organize meetings to go through errors identified. He/She will maintain accurate and reliable reporting that contains audit scores of the department and the team members. The Quality Improvement Analyst will also develop a communication plan that highlights potential causes of errors, and conduct training to mitigate future errors.

Responsibilities will include:

• Perform quality review of random claim samples as they relate to claim adjudication, claim adjustments, and auto adjudication to ensure standards are met for procedural and financial accuracy
• Work to identify, document, and propose solutions for areas of improvement
• Develop, implement, and maintain worksheets that support the overall details of the QA program within the claims department
• Provide timely detailed reports that outline departmental and individual statistical results
• Support the claims department by reviewing procedural documentation on claims processing. Provide recommendations based on findings
• Perform other duties as assigned to support claims functions

Attributes to success:

• Curiosity and willingness to ask questions
• A deep desire to improve and make a change in the healthcare experience
• Preference towards collaboration and preventing silos
• You will roll up your sleeves and do whatever it takes to get the job done

Desired skills and experience:

• 3-5 years experience in a claims auditor role
• 5-7 years of experience processing basic and complex claims
• Spreadsheet and database skills required
• Excellent written, verbal, and interpersonal communication skills required
• Quality assurance program experience required
• Experience working on; contract configuration, benefit configuration, SIU/FWA a plus
• CPC (Certified Professional Coder) also a plus

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!