Senior Vice President, Claims Services and Solutions

TL;DR

Senior Vice President, Claims Services and Solutions (Healthcare Payer Claims): Lead and transform a multi-client healthcare payer claims services organization from claim receipt through final disposition with an accent on operational excellence, quality/error reduction, and technology-enabled workflow governance. Focus on executive client engagement, claims operating model stabilization/turnaround, and translating claims needs into analytics, automation, and AI-enabled quality processes.

Location: Tampa, Florida (Remote)

Company

hirify.global provides technology-enabled claims administration, BPO, digital transformation, document management, and contact center solutions for healthcare plans.

What you will do

• Build and scale a high-performing, multi-client claims operating model from intake through final disposition.
• Drive operational excellence across quality, turnaround time, productivity, pends, inventory/backlog, workforce readiness, and service-level commitments.
• Lead turnaround and stabilization initiatives for complex or underperforming claims environments.
• Strengthen quality assurance, audit discipline, root-cause resolution, coaching, release controls, and measurable error reduction.
• Establish claims rule governance, knowledge management, version-controlled client instructions, and single-source-of-truth practices.
• Partner with Technology and Product to define requirements for workflow, routing, dashboards, audit tracking, knowledge access, release controls, automation, and AI-enabled quality processes.

Requirements

• 15+ years of progressive healthcare payer claims experience, including claims processing, adjudication, quality, productivity, service levels, and operational performance management.
• 10+ years leading claims operations/claims services/claims delivery or claims transformation in a healthcare payer BPO, outsourcing, managed services, BPaaS, or similar client-services environment.
• Proven results improving quality, reducing backlog/aging, increasing productivity, stabilizing operations, and rebuilding client confidence.
• End-to-end claims process ownership experience (intake, assignment, workflow, pends, QA, release governance, reporting, escalation, final disposition).
• Executive-level client relationship experience including governance meetings, QBRs, steering committees, escalations, renewal support, and recovery conversations.
• California healthcare payer experience required (experience supporting California-based health plans, Medi-Cal programs, California managed care organizations, and comparable California payer environments).

Culture & Benefits

• Remote work based in Tampa, Florida.
• Opportunity to modernize claims operations and shape the technology roadmap and client experience.
• Work across Sales, Client Services, Technology, Product, and Executive Leadership to drive growth and transformation.
• Focus on measurable improvements in operational performance, client satisfaction, and employee engagement.

Hiring process

• Confidential conversation to discuss fit and scope of transformation leadership.