Lead Stop Loss Claims Operations & Transformation

Personify Health; Tempe, Northern (AZ, KY); Hybrid; USD 107,000 - 140,000; Full time

Job summary

Personify Health is seeking a Sr. Manager, Stop Loss Claims Operations to lead the strategy, transformation, and financial outcomes of the Stop Loss function.

The role blends operational excellence with strong vendor and carrier negotiations, designed for a leader who can scale processes and improve reimbursement results. Remote flexibility is offered, with on-site work required for Tempe, AZ within commuting distance.

Qualifications

• Bachelor's degree in Finance, Healthcare Administration, Business, or 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
• Experience leading enterprise-level transformation initiatives and scaling operations

Responsibilities

• Define and execute the Stop Loss operating model, aligning goals and ensuring accountability
• Drive financial performance and reimbursement outcomes across claims and cash flow
• Lead enterprise transformation initiatives and modernize systems
• Oversee the full claim lifecycle at a strategic level and manage high-risk situations
• Build and evolve data and analytics capabilities for insights and forecasting
• Establish governance, compliance, and risk controls
• Partner cross-functionally at the executive level across Finance, Underwriting, Claims, Client Services, Compliance, and IT
• Lead and develop a multi-level leadership team
• Shape external partnerships with TPAs, carriers, and vendors
• Drive enterprise-wide strategic initiatives like M&A integrations and new product implementations

Skills

Stop Loss operations

Claims management

Reimbursement processes

Medical coding ICD-10 CPT HCPCS

Financial budgeting forecasting

Excel & analytics

Lean Six Sigma

Financial modeling

Risk management

Education

Bachelor's degree in Finance, Healthcare Administration, Business, or related field

Master's degree preferred

Tools

Excel

Analytics tools

Data visualization platforms

Database management systems

Job description

Personify Health is seeking a Sr. Manager, Stop Loss Claims Operations to lead the strategy, transformation, and financial outcomes of the Stop Loss function.

The role blends operational excellence with strong vendor and carrier negotiations, designed for a leader who can scale processes and improve reimbursement results. Remote flexibility is offered, with on-site work required for Tempe, AZ within commuting distance.