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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