Senior Manager Of Claims (Healthcare)

TL;DR

Senior Manager of Claims (Healthcare): Leading claims operations and a team of examiners to ensure accurate, compliant, and timely adjudication of high-risk and complex health claims. Focus on driving process improvements, managing regulatory responses, and optimizing operational efficiency to support client satisfaction and business growth.

Location: Must be based in Tempe, AZ (On-site)

Salary: $107,000 - $140,000

Company

hirify.global provides a personalized health platform that integrates health plan administration, wellbeing solutions, and care navigation to improve health outcomes and reduce costs.

What you will do

• Lead, coach, and develop a team of claims examiners handling complex and high-risk cases.
• Oversee the resolution of pended, high-dollar, and special-handling claims to ensure accuracy and policy adherence.
• Manage responses to regulatory audits, legal requests, and insurance complaints while maintaining strict documentation.
• Drive operational compliance with Medicare, HIPAA, and other regulatory standards.
• Identify workflow inefficiencies and partner with IT and leadership to implement system enhancements and increase auto-adjudication rates.
• Monitor KPIs to track accuracy and productivity, translating data into actionable insights for leadership.

Requirements

• 10+ years of experience in claims operations, preferably within a TPA environment.
• 5+ years of leadership or supervisory experience in claims management.
• Deep knowledge of claims processing systems, workflows, and regulatory requirements including Medicare, HIPAA, and DOL.
• Experience with EDI processes and claims adjudication platforms.
• Proficiency in KPI analysis, reporting, and process improvement methodologies.
• Must be available to work on-site in Tempe, AZ on a full-time basis.

Nice to have

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

Culture & Benefits

• Comprehensive medical and dental coverage through internal health solutions.
• Unlimited PTO policy.
• Mental health support, retirement planning, and financial protection benefits.
• Professional development opportunities with clear career progression and learning budgets.
• Mission-driven culture focused on improving people's health and wellbeing.