Senior Manager, Medical Loss Ratio

Location: Remote from anywhere in the Continental United States

Salary: $107,700–$199,300 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Lead the MLR compliance and reporting program across assigned lines of business, overseeing reporting calendars and timely federal and state filings.
• Review MLR methodologies, assumptions, classifications, reconciliations, and variance analyses for accuracy and regulatory alignment.
• Establish governance, internal controls, documentation standards, audit readiness, and risk-based monitoring plans.
• Oversee MLR performance monitoring, rebate planning and execution, corrective actions, audits, examinations, and regulatory inquiries.
• Coordinate decisions and issue resolution with Finance, Actuarial, Legal/Compliance, Government Affairs, and operational partners.
• Lead, coach, and develop the team while providing executive-ready reporting and driving process improvement, automation, and data governance initiatives.

Requirements

• Must be authorized to work in the U.S. without current or future employment-based visa sponsorship.
• Bachelor’s degree in Finance, Accounting, Actuarial Science, Business, Healthcare Administration, Public Health, or a related field, or equivalent experience.
• At least 4 years of healthcare finance, managed care operations, or related experience.
• Experience interpreting federal and state MLR guidance and applying judgment to complex classification and methodology issues.
• Experience reviewing complex analyses and maintaining documentation suitable for audits and regulatory submissions.
• Advanced Excel and reporting or analytics tools experience, plus the ability to influence senior leaders and cross-functional stakeholders.

Nice to have

• Juris Doctor or master’s degree.
• Experience with health plan finance or claims systems and data warehouses.
• CPA, CMA, CIA, CHC, CRC, or another relevant accounting, audit, or healthcare compliance credential.

Culture & Benefits

• Flexible remote, hybrid, field, or office work schedules.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Equal opportunity workplace committed to diversity and inclusion.