Remote New

Payment & Outcomes Rules Manager

Delta Dental of California
$92,500 - $200,400
dental insurance, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States
Nov 24, 2025
JOB DESCRIPTION The Manager of Payment Rules & Outcomes is a key strategic leader in managing Delta Dental's health care industry rule practices, rule architecture, business capabilities, and administration of clinical and non-clinical policies to ensure quality outcomes and accurate payment. This role leads a team of analysts that support identification of new rules to enable policy and ensure quality outcomes and accurate payments, while also monitoring the efficacy of existing rules. This Manager is a trusted thought partner to support the various Quality and Enterprise efforts driving quality outcomes and delivering quality of care. RESPONSIBILITIES Oversees business and clinical policy administrative rules and business "ownership" for the tool(s) enabling claim or clinical outcome rules; including oversight of any external third-party partners that are administering claim outcome and/or payment rules on Delta Dental's behalf to ensure consistent and accurate outcomes and performance. Leads a team of Outcome Rules Analysts that work cross-functionally to ensure Delta Dental has the right monitoring and controls in place to continuously and proactively evaluate rules in production, ensuring accuracy and effectiveness. Leads cross-functional discussions with various Data, Analytics, Reporting, Insights, Technology and Business stakeholders to discuss new opportunities within the claims and clinical ecosystem, and to formulate recommendations and comprehensive remediation plans inclusive of holistic business cases for any new, enhanced or eliminated rules. Ensures outcome rules are appropriately accessible and transparent both internally and externally, and supports enterprise-wide educational opportunities. Leads health care industry research to ensure best practice rule management methodologies are documented, implemented, and communicated to stakeholders regularly. Develops and maintains a comprehensive approach to analysis and reporting of outcome rule performance, trends and opportunities that are accessible to stakeholders. Leads cross-functional discussions to influence Policy and Payment Quality Management strategy, prioritization and multi-year roadmaps. Develops and maintains strong partnerships with functional leaders (including Business Directors, Senior Product Managers, Technology Managers, and other Product Managers), across the enterprise to drive focus on business objectives. Manages and develops multi-disciplinary teams to achieve strategic objectives, encompassing determining staffing needs, setting goals, monitoring performance, interviewing, selecting, coaching, and evaluating the performance of all direct reports, overseeing, and maintaining department budgets. QUALIFICATIONS 8+ years w/Bachelor's degree; 1+ years supervisory/management. Additional experience may be accepted in lieu of education or degree. Experience in claims and/or clinical outcome determination preferred. Experience in aggregating internal and external complex information to address business problems and working cross-functionality to build the story and deliver the message to Sr. Leaders in support of business decisions. Strong people-leadership skillset, including talent development and the ability to realize strategies through a team. High detail orientation with strong analytical, critical thinking and problem-solving skills. Excellent organizational/time management and project management skills. Extensive knowledge of health care industry. Excellent interpersonal, verbal, and written communication skills, including proven ability to collaborate and influence across all functions and levels of the organization. Proven ability to resolve conflict and facilitate decision-making. Strong presentation skills. Should be comfortable with presenting to all levels of management. A problem solver and planner, has strong quality control, adaptability, and customer service skills. Ability to break down complex problems into pieces that can be solved with data, analysis, assumptions, and judgment. Ability to synthesize large amounts of complex information to determine correlations in the data and summarize in a way that is digestive to stakeholders. Ability to represent the business and work cross-functionally to ensure the enterprise is deploying the right rules and optimal solution patterns for accurate policy and payment administration. Advanced technical knowledge is preferred. Base Pay Information The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. Pay Grade 22. $92,500 - $200,400 ADDITIONAL INFORMATION Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes: Competitive base and incentive pay 401(k) with robust matching and non-matching contributions Rich medical & pharmacy benefits 100% employer-paid dental and vision benefits Holistic wellbeing program with deep financial incentives Generous paid time off plus 12 paid holidays and your birthday off Culture of growth and learning: career development; tuition reimbursement; recognition program Family support: adoption assistance, fertility treatment, child, elder & pet care assistance Social responsibility and volunteer opportunities Employee discount program Fair Chance Ordinances and Criminal Background Considerations This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A. Important Work Authorization Information Please note, Delta Dental will not sponsor applicants for work visas for this position. #LI-Remote ABOUT THE TEAM At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building fair programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all. We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie. Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us! Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands. The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company. Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies. Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time. Proof of eligibility to work in the United States must be provided if selected for hire. Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York If You Are A Current Employee Click Here* To Apply