Senior Stop Loss Operations Leader - Remote & High Impact

Personify Health; United States; Hybrid; USD 107,000 - 140,000; Full time

Benefits offered by this job

Base salary + benefits from day one

Comprehensive medical & dental

Unlimited PTO

Mental health support

Retirement planning

Professional development & learning

Job summary

Personify Health is seeking a Senior Manager of Stop Loss to define the operating model, drive reimbursement outcomes, and lead enterprise-wide transformation across the Stop Loss function. You will oversee claims lifecycle, ensure compliance, and optimize cash flow while partnering with executive teams to shape strategy and risk management.

This role requires a proven leadership track record in complex healthcare operations.

Qualifications

• 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

Responsibilities

• Define and execute the Stop Loss operating model: Set long-term vision, strategy, and structure for the function.
• Drive financial performance and reimbursement outcomes: Own results across claim filings, reimbursement recovery, and cash flow management.
• Lead enterprise transformation initiatives: Sponsor and direct large-scale system implementations, automation strategies, and workflow redesigns.
• Oversee the full claim lifecycle at a strategic level: Ensure accuracy, compliance, and maximized reimbursement across claims.
• Build and evolve data and analytics capabilities: Oversee reporting strategies and advanced analytics for insights.
• Establish governance, compliance, and risk controls: Develop audit frameworks and governance structures.
• Partner cross-functionally at the executive level: Influence decisions with Finance, Underwriting, Claims, Client Services, Compliance, IT.
• Lead and develop a multi-level leadership team: Build leadership capability and coach managers.
• Shape external partnerships and carrier relationships: Build strategic relationships with TPAs, carriers, vendors.
• Lead enterprise-wide strategic initiatives: Drive M&A integrations, new product implementations, process standardization.

Skills

Stop loss operations

Claims management

Financial acumen

Excel & analytics

Data visualization

Lean Six Sigma

Risk management principles

Education

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

Master's degree preferred

Tools

Microsoft Excel

Analytics tools

Data visualization platforms

Database management systems

Job description

Personify Health is seeking a Senior Manager of Stop Loss to define the operating model, drive reimbursement outcomes, and lead enterprise-wide transformation across the Stop Loss function. You will oversee claims lifecycle, ensure compliance, and optimize cash flow while partnering with executive teams to shape strategy and risk management.

This role requires a proven leadership track record in complex healthcare operations.