Teams at Devoted Health

Lead and optimize Utilization Management by translating regulatory guidance into compliant workflows, driving process and technology improvements, managing cross-functional stakeholders and vendors, and using data and AI-enabled tools to improve decision accuracy and operational efficiency.

Investigate complex claims issues end-to-end, perform root cause analysis, identify systemic trends, partner cross-functionally to implement durable process improvements, document decision frameworks, use data to validate impact, and explore AI/LLM-driven automation to improve investigation quality and efficiency.

Support SIU fraud detection by analyzing large healthcare claims datasets, triaging referrals, preparing investigative reports, coordinating with internal teams, managing CMS fraud reports, conducting QA of case files, and developing education and mitigation strategies for fraud, waste, and abuse.