Sr. Manager, Stop Loss Claims Operations (Healthcare TPA)

TL;DR

Sr. Manager, Stop Loss Claims Operations (Healthcare TPA): Defining and scaling stop loss claims operations, reimbursement strategy, and financial performance with an accent on claims accuracy, recovery optimization, governance, and enterprise transformation. Focus on modernizing systems, negotiating with carriers, building analytics capabilities, and leading complex cross-functional initiatives.

Location: Remote within the United States. Candidates within commuting distance of Tempe, Arizona must work onsite regularly.

Salary: $107,000–$140,000 base salary, depending on location, skills, and experience.

Company

Personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Define the long-term operating model, strategy, structure, goals, and accountability for stop loss operations.
• Own claim filings, reimbursement recovery, cash flow management, and financial leakage reduction.
• Lead system implementations, automation, workflow redesign, M&A integrations, and other enterprise transformation initiatives.
• Oversee complex specific and aggregate claims, carrier negotiations, compliance, audits, governance, and risk controls.
• Build reporting and analytics capabilities for claims performance, reimbursement trends, forecasting, and data integrity.
• Lead managers and supervisors while partnering with Finance, Underwriting, Claims, Client Services, Compliance, IT, carriers, TPAs, and vendors.

Requirements

• Bachelor's degree in Finance, Healthcare Administration, Business, or a related field; a master's degree is preferred.
• 10+ years of stop loss, TPA, or healthcare claims experience, including reimbursement strategy and claims adjudication.
• 5+ years of progressive leadership experience managing managers and large or complex teams.
• Demonstrated success leading enterprise-level transformation initiatives and scaling operations.
• Expert knowledge of stop loss operations, claims management, reimbursement processes, medical terminology, and ICD-10, CPT, and HCPCS coding.
• Advanced financial, analytics, Excel, contract, risk management, and continuous improvement expertise, including Lean or Six Sigma.

Culture & Benefits

• Benefits begin on the first day of employment.
• Medical and dental coverage, including access to company health solutions.
• Unlimited paid time off, mental health support, retirement planning, and financial protection.
• Professional development, learning budgets, and clear career progression.
• Mission-driven environment focused on improving health outcomes and valuing diverse perspectives.