Hiring: Sr. Manager, Stop Loss Claims Operations Company: Personify Health Location: United States Job Posted Time: 2026-09-10 11:36:26 Employment Type: Contract / Remote Target Skills & Keywords : CPT, Change Management, ICD-10, Microsoft Excel, REST, Risk Management, Six Sigma About the job Experience: •10+ years of Stop Loss, TPA, or healthcare claims experience with deep expertise in reimbursement strategy and claims adjudication •5+ years of progressive leadership experience, including managing managers and leading large or complex teams •Demonstrated success leading enterprise-level transformation initiatives and scaling operations Required Skills: •Ready to shape the strategy, lead the transformation, and own the financial outcomes for a critical enterprise function? •This position offers flexibility for remote candidates. For candidates residing within commuting distance of our Tempe, AZ location, regular on-site work from the office will be required. •Define and execute the Stop Loss operating model: Set the long-term vision, strategy, and structure for the function — translating corporate priorities into departmental goals and ensuring every team is aligned and accountable. •Drive financial performance and reimbursement outcomes: Own the results across claim filings, reimbursement recovery, and cash flow management, with a relentless focus on eliminating financial leakage and optimizing recovery. •Lead enterprise transformation initiatives: Sponsor and direct large-scale system implementations, automation strategies, and workflow redesigns that modernize operations and position the function for sustainable growth. •Oversee the full claim lifecycle at a strategic level: Ensure accuracy, compliance, and maximized reimbursement across specific and aggregate claims — with direct involvement in high-risk, complex, and escalated situations and carrier negotiations. •Build and evolve data and analytics capabilities: Oversee reporting strategies and advanced analytics that surface actionable insights on claims performance, reimbursement trends, and financial forecasting — and ensure data integrity across all systems. •Establish governance, compliance, and risk controls: Develop and maintain audit frameworks, compliance processes, and governance structures that keep the function aligned with regulatory requirements, contractual obligations, and internal policy. Qualifications: •Bachelor's degree in Finance, Healthcare Administration, Business, or a related field required; Master's degree preferred Compensation: •$107,000 - $140,000 / year •Comprehensive medical and dental through our own health solutions (yes, we use what we build) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!