Sr. Manager Healthcare Claims

Location: Remote within the United States. Candidates within commuting distance of Tempe, Arizona, must work onsite regularly.

Salary: $107,000–$140,000 base salary per year, depending on location, skills, and experience.

Company

hirify.global provides a personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Lead, coach, and develop a team of claims examiners handling complex and high-risk claims.
• Oversee the end-to-end resolution of pended, high-dollar, and special-handling claims.
• Resolve escalated payment discrepancies and support fraud investigations and complex inquiries.
• Coordinate responses to audits, legal requests, insurance complaints, Department of Labor matters, and regulatory inquiries.
• Improve workflows, standardize procedures, increase auto-adjudication, and reduce manual intervention.
• Partner with IT, legal, compliance, and vendors on system enhancements, EDI optimization, implementations, RFPs, and growth initiatives.

Requirements

• 7+ years of experience in claims operations, preferably in a third-party administrator environment.
• 5+ years of leadership or supervisory experience in claims management.
• Deep knowledge of claims processing systems, workflows, Medicare, HIPAA, and Department of Labor requirements.
• Experience with EDI processes and claims adjudication platforms.
• Proficiency in KPI analysis, reporting, and process improvement methodologies.
• Familiarity with audit responses, compliance documentation, and legal or regulatory coordination.

Nice to have

• Bachelor’s degree in Business Administration, Health Administration, or a related field.

Culture & Benefits

• Competitive base salary and benefits effective from day one.
• Medical and dental coverage through hirify.global’s own health solutions.
• Unlimited paid time off.
• Mental health support, retirement planning, and financial protection.
• Professional development, career progression, and learning budgets.
• Mission-driven environment focused on improving people’s health.