Claims Operations Manager (Healthcare)

TL;DR

Claims Operations Manager (Healthcare): Leading the end-to-end modernization of member reimbursement workflows for medical and supplemental expenses with an accent on operational deployment and system scalability. Focus on deploying AI and data platforms to optimize business outcomes and ensure 100% regulatory compliance.

Location: Remote (USA)

Salary: $90,000 - $125,000

Company

hirify.global is an all-in-one healthcare company combining insurance, clinical care, and technology to improve the health and well-being of older Americans.

What you will do

• Lead the end-to-end modernization of member reimbursement workflows for medical and supplemental expenses.
• Deploy internal toolkits, including AI, workforce, and data platforms, to achieve specific business outcomes.
• Define and own the "Source of Truth" for program health and performance metrics.
• Build and manage BI dashboards to track KPIs and implement immediate corrective actions.
• Engineer processes to ensure 100% compliance with internal and external regulations.

Requirements

• Proven ability to use complex data sets to drive performance and influence organizational outcomes.
• Proficiency with BI platforms such as Snowflake, Looker, or Tableau.
• Track record of using LLMs or automation to solve business problems.
• Bachelor’s degree or equivalent experience in a high-growth or regulated environment.
• Must be based in the USA.

Nice to have

• Background in healthcare technology, management consulting, or tech-ops.
• Experience as a Subject Matter Expert in complex tools or regulatory frameworks.
• Experience building collaborative relationships with cross-functional partners and offshore teams.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and a dedicated parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility for non-Director roles.
• 401K program.