Sr. Manager of Stop Loss

Personify Health•Tempe, AZ

2d•$107,000 - $140,000•Onsite

About The Position

This role sits at the center of where financial risk, operational precision, and client trust all converge within the Stop Loss function. As Senior Manager of Stop Loss, you will be responsible for defining how the function operates, scales, and performs across the enterprise. Your decisions will directly influence Personify Health's financial outcomes and competitive positioning, from reimbursement optimization to carrier negotiations to large-scale transformation initiatives. 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.

Requirements

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
5–7+ years of progressive leadership experience, including managing managers and leading large or complex teams
Demonstrated success leading enterprise-level transformation initiatives and scaling operations
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

Responsibilities

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.