Senior Manager, Strategic Configuration (Healthcare)

TL;DR

Senior Manager, Strategic Configuration (Healthcare): Leading the technical design and optimization of first-pass claim payment accuracy for a Medicare Advantage plan with an accent on contract logic, clinical edits, and reimbursement rules. Focus on identifying configuration gaps, implementing precision-based review triggers, and integrating automated solutions to reduce payment variances.

Location: Remote (USA)

Salary: $129,000 - $168,000 USD

Company

hirify.global is a technology-driven Medicare Advantage plan focused on improving member health through data-driven personalized care and custom software.

What you will do

• Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication.
• Optimize edit logic and implement precision-based review triggers to minimize payment inaccuracies at initial intake.
• Drive the integration of automated solutions and data-forward strategies to proactively mitigate configuration gaps.
• Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance teams.
• Provide "player-coach" leadership for a lean team of specialists, fostering a culture of technical excellence.
• Develop and maintain best practices and technical documentation for advanced configuration procedures.

Requirements

• 7+ years of experience in Medicare Advantage or healthcare plan configuration.
• 3+ years of experience in a leadership or managerial role.
• Deep technical expertise in complex provider contracts, clinical edits, and general reimbursement logic.
• High proficiency in health plan systems such as HealthEdge HRP and Source.
• Must be based in the USA.
• Proven track record of driving systemic process improvements and strong project management skills.

Culture & Benefits

• Competitive base salary, equity opportunities, and a performance-based bonus program.
• Comprehensive medical, dental, and vision coverage with 401k matching.
• Remote-first culture featuring No-Meeting Fridays, monthly company holidays, and a generous flexible time-off policy.
• Investment in growth through learning programs, mentorship, and professional development funding.
• Additional perks including ESPP, reimbursement for office setup, and monthly cell phone and internet stipends.