Senior Manager Of Health Claims

TL;DR

Senior Manager of Health Claims: Leading claims operations and a team of examiners to ensure accurate, compliant, and timely adjudication of complex health claims with an accent on regulatory adherence and process optimization. Focus on driving operational efficiency, managing high-stakes escalations, and collaborating cross-functionally to improve system performance.

Location: Must be based in Tempe, AZ and available to work on-site full-time.

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 high-risk and complex cases.
• Oversee the resolution of pended, high-dollar, and special-handling claims to ensure accuracy and policy compliance.
• Manage responses to regulatory audits, legal requests, and Department of Labor inquiries.
• Identify operational inefficiencies and implement process improvements to increase auto-adjudication rates.
• Collaborate with IT, legal, and compliance teams to support system enhancements and EDI process optimization.
• Monitor KPIs to track accuracy and productivity, providing actionable insights to leadership.

Requirements

• 10+ years of experience in claims operations, preferably in 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.
• Bachelor's degree in Business Administration, Health Administration, or related field preferred.

Culture & Benefits

• Comprehensive medical and dental coverage through company 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 health outcomes.