Claims Manager

Sr. Manager, Stop Loss Claims Operations Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Ready to shape the strategy, lead the transformation, and own the financial outcomes for a critical enterprise function? Why This Role Matters Stop loss is where financial risk, operational precision, and client trust all converge — and this role sits at the center of it. As Senior Manager of Stop Loss, you're not just managing a department; you're defining how the function operates, scales, and performs across the enterprise. From reimbursement optimization to carrier negotiations to large-scale transformation initiatives, your decisions directly influence Personify Health's financial outcomes and competitive positioning. The leaders you develop, the systems you modernize, and the strategies you execute will determine how well the organization manages risk and delivers for clients in an industry that never stops evolving. Work Location: 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. What You'll Actually Do 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. Partner cross-functionally at the executive level: Influence enterprise decisions across Finance, Underwriting, Claims, Client Services, Compliance, and IT — and represent Stop Loss in steering committees, executive forums, and strategic planning discussions. Lead and develop a multi-level leadership team: Build leadership capability, drive succession planning, and coach managers and supervisors on performance management, change leadership, and operational excellence. Shape external partnerships and carrier relationships: Build and negotiate strategic relationships with TPAs, carriers, and vendors to drive service excellence and favorable financial outcomes. Lead enterprise-wide strategic initiatives: Drive M&A integrations, new product implementations, process standardization, and change management efforts that expand organizational capability and deliver measurable business impact. What You Bring to Our Team Education & Experience: Bachelor's degree in Finance, Healthcare Administration, Business, or a related field required; Master's degree preferred 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 Technical Skills: Expert-level knowledge of stop loss operations, claims management, and reimbursement processes Strong understanding of medical terminology and coding (ICD-10, CPT, HCPCS) Advanced financial acumen including budgeting, forecasting, and revenue optimization Advanced proficiency in Microsoft Excel and analytics tools; experience with data visualization platforms and database management systems preferred Familiarity with Lean, Six Sigma, or comparable continuous improvement methodologies Knowledge of stop loss contract structures, financial modeling, and risk management principles The Highlights: Competitive base salary and benefits effective day one Comprehensive medical and dental through our own health solutions (yes, we use what we build) Unlimited PTO—rest and recharge time is non-negotiable Mental health support, retirement planning, and financial protection Professional development with clear career progression and learning budgets Mission-driven culture where diverse perspectives drive real impact on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $107,000 - $140,000, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to View email address on click.appcast.io . View all legitimate openings at personifyhealth.com/careers . #J-18808-Ljbffr