Senior Manager, Stop Loss Claims Operations (Healthcare Claims)

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

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

Company

hirify.global provides a 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 performance.
• Lead system implementations, automation, workflow redesign, M&A integrations, and other enterprise transformation initiatives.
• Oversee the strategic claim lifecycle, including complex and escalated specific and aggregate claims, compliance, accuracy, reimbursement, and carrier negotiations.
• Build reporting and advanced analytics capabilities covering claims performance, reimbursement trends, forecasting, and data integrity.
• Develop governance, audit, compliance, risk controls, executive partnerships, carrier relationships, and a multi-level leadership team.

Requirements

• Bachelor’s degree in Finance, Healthcare Administration, Business, or a related field required; 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.
• Expert knowledge of stop loss operations, claims management, reimbursement processes, contract structures, financial modeling, and risk management.
• Strong understanding of medical terminology and ICD-10, CPT, and HCPCS coding.
• Advanced financial, Excel, analytics, data visualization, database management, and continuous improvement skills.

Culture & Benefits

• Competitive base salary with benefits effective from day one.
• Medical and dental coverage through hirify.global’s own 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 diversity, inclusion, and improving health outcomes.