Sr. Manager Of Healthcare Claims (TPA)

TL;DR

Sr. Manager of Healthcare Claims (TPA): Leading a team of claims examiners to ensure accurate and timely adjudication of complex, high-risk healthcare claims with an accent on operational efficiency and regulatory compliance. Focus on resolving escalated payment discrepancies, managing regulatory audits, and optimizing EDI processes to reduce manual intervention.

Location: On-site in Tempe, AZ. Candidates must be available to work from the office on a full-time basis.

Salary: $107,000 - $140,000

Company

hirify.global provides a personalized health platform integrating health plan administration, wellbeing solutions, and care navigation to improve health outcomes.

What you will do

• Lead and develop a claims team, coaching examiners handling high-risk and complex cases to drive performance.
• Own the resolution of pended and high-dollar claims, ensuring timely adjudication according to policies.
• Manage regulatory and legal responses, coordinating audits and inquiries from the Department of Labor.
• Ensure strict adherence to Medicare, HIPAA, and other applicable regulatory standards across operations.
• Identify and fix operational inefficiencies to increase auto-adjudication rates and reduce manual intervention.
• Monitor KPIs and translate turnaround metrics into actionable recommendations for leadership.

Requirements

• Must be available to work on-site full-time in Tempe, AZ.
• 7+ years of experience in claims operations, preferably within a TPA environment.
• 5+ years of leadership or supervisory experience in claims management.
• Deep knowledge of Medicare, HIPAA, and DOL regulatory requirements.
• Experience with electronic data interchange (EDI) processes and adjudication platforms.
• Bachelor's degree in Business Administration, Health Administration, or a related field preferred.

Culture & Benefits

• Comprehensive medical and dental benefits effective from day one.
• Unlimited PTO to ensure employees can rest and recharge.
• Mental health support, retirement planning, and financial protection.
• Professional development budgets and clear paths for career progression.
• Mission-driven culture that celebrates diversity and impact on people's health.