Claims Operations Manager (Refund Management)

TL;DR

Claims Operations Manager (Refund Management): Leading the end-to-end transformation of the provider refund ecosystem with an accent on automation, data-driven recovery, and regulatory compliance. Focus on designing scalable refund engines, managing the full check lifecycle, and ensuring audit-readiness within a high-growth healthcare environment.

Location: Remote (USA only)

Salary: $73,000–$125,000 / year

Company

hirify.global is an all-in-one healthcare company dedicated to improving the well-being of older Americans through integrated clinical care, insurance, and technology.

What you will do

• Lead the modernization of the provider refund ecosystem by designing and deploying automated processing engines.
• Own the refund check lifecycle, ensuring recoupment targets are met and operational leakage is eliminated.
• Build and manage BI dashboards to track recovery trends and performance metrics.
• Ensure 100% compliance with CMS regulatory timelines and lead monthly audit processes.
• Act as a cross-functional liaison between Payment Integrity, Finance, and Product teams to address root causes of overpayments.

Requirements

• Must be based in the United States
• Proven experience as an operator in a high-growth or regulated environment.
• Proficiency with BI platforms such as Snowflake, Looker, or Tableau.
• Strong analytical skills with the ability to use complex data sets to drive performance.
• Experience using automation or LLMs to solve business problems.
• Bachelor’s degree or equivalent professional experience.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave program.
• 401K program and stock options for all employees.
• $100 monthly mobile or internet stipend.
• Commitment to a diverse, vibrant, and supportive work environment.