Head Of Claim Operations (AI)

TL;DR

Head of Claim Operations (Healthcare/AI): Owning and scaling the claims engine for a consumer-driven major medical insurance model with an accent on AI-enabled automation and operational excellence. Focus on increasing auto-adjudication rates, shaping the technology roadmap, and driving compliance rigor.

Location: Remote (Must be based in the United States)

Company

hirify.global is a mission-driven company redefining health insurance to make healthcare more affordable and accessible in the US.

What you will do

• Lead and scale a multidisciplinary Claims Operations team encompassing adjudication, quality, and clinical functions.
• Drive AI and automation strategies to significantly increase end-to-end auto-adjudication rates and reduce processing time.
• Partner with Product and Engineering to strategically shape the claims technology roadmap.
• Manage payment accuracy, fraud prevention, and claims spend optimization.
• Translate operational data into strategic insights and recommendations for senior leadership.
• Ensure full compliance with healthcare regulations and oversee budget development and resource allocation.

Requirements

• 15+ years of operations experience, including 5+ years in healthcare.
• 8+ years in senior leadership roles managing large teams in complex environments.
• Proven track record of deploying AI or automation in claims or complex operations.
• Strong financial acumen with experience in budget and headcount planning.
• Ability to build and interpret operational dashboards and lead through metric-based goals.
• Must be authorized to work in the US (indicated by US-specific benefits like 401k).

Culture & Benefits

• Competitive salary, bonus opportunity, and equity package.
• Comprehensive Medical, Dental, and Vision benefits.
• 401k retirement plan.
• Paid vacation and company holidays.
• Opportunity to drive impact at a rapidly growing company transforming the US healthcare system.