Our Senior Manager of Claims is a leadership role responsible for overseeing end-to-end claims processing operations, enterprise risk management, and regulatory compliance. In this role you will lead a multi-functional team and serve as a strategic partner across the organization to ensure operational integrity, regulatory adherence, and continuous improvement. This role manages the claims payment program and is responsible for establishing sound claims practices and policies, the claims payment process, is the direct contact for internal and external clients, and informs, delivers and ensures on time and accurate implementation of claims processes and client programs for the WHL product.  Additionally, you will participate in thorough investigations, settlements and legal reviews, as needed.

Claims Operations Leadership

1. Oversee end-to-end claims processing operations, ensuring accuracy, efficiency, and adherence to service level agreements.
2. Lead and develop a team of claims professionals, supervisors, and analysts across multiple claims functions.
3. Establish and monitor KPIs including claim cycle time, denial rates, accuracy rates, and cost per claim.
4. Drive continuous process improvement initiatives leveraging automation and technology to reduce manual touchpoints.

Risk Management

1. Identify, assess, and mitigate operational risks across the claims lifecycle.
2. Develop and maintain a claims risk register, escalation protocols, and informs business continuity plans.
3. Partner with finance and legal teams to assess claims liability exposure and trending.
4. Monitor fraud, waste, and abuse indicators and coordinate investigation protocols with appropriate stakeholders.

Compliance & Regulatory Oversight

1. Ensure claims operations align with federal and state regulations, including CMS guidelines, HIPAA, and applicable plan-specific requirements.
2. Lead audit readiness efforts and serve as the primary operational point of contact during internal and external audits.
3. Maintain current knowledge of regulatory changes and translate compliance requirements into operational policy and procedure updates.
4. Develop and implement compliance training programs for claims staff.

Strategic & Cross-Functional Leadership

1. Collaborate with IT, legal, finance, and vendor partners to align claims systems and workflows with organizational goals.
2. Present operational performance, risk posture, and compliance status to senior leadership and other stakeholders as needed.
3. Support organizational growth initiatives including new product lines, client implementations, acquisitions, or system migrations from a claims operations perspective.

Other duties as assigned.

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field preferred. Equivalent work experience will be considered.
• 7–10 years of progressive experience in claims operations, with at least 3–5 years in a leadership role.
• Demonstrated experience managing cross-functional teams in a regulated industry, preferably healthcare or insurance.
• Proven track record of building and executing compliance programs aligned with CMS, HIPAA, or state regulatory frameworks.
• Experience leading operational audits, responding to regulatory inquiries, or managing accreditation processes.
• Hands-on experience implementing process automation, claims management systems, or workflow technology.
• Strong background in risk identification, mitigation planning, and operational controls.
• Experience presenting to Senior and Executive leadership, Board members, or external regulatory bodies preferred.
• Commercial, Medicare Advantage, Medicaid, or supplemental health plan experience required.
• Excellent verbal, written and presentation skills
• Excellent problem solving and data analysis ability
• Excellent organizational and time management skills
• Proficiency using MS Office (Excel, Word, PowerPoint, Access)
• Experience using a variety of automated claims processing systems, Plexis/Orion experience a plus.
• Exceptional customer service skills.
• Relevant certifications preferred: Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC), Six Sigma Green or Black Belt, Associate in Claims (AIC).

The salary range for this opportunity is $74,800 to $102,300. Compensation depends on several factors: qualifications, skills, competencies, and experience.

Tivity Health offers a robust benefits package, which includes a competitive salary, company bonus potential, medical, dental, vision, 401k with match, generous paid time off, free gym membership to over 13,000 fitness locations in the US, and other great benefits.

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About Tivity Health® Inc. 
Tivity Health, Inc. is a leading provider of healthy life-changing solutions, including SilverSneakers®, ForeverFit®, and WholeHealth Living®. We help adults improve their health and support them on life's journey by providing access to in-person and virtual physical activity, social and mental enrichment programs, as well as a full suite of physical medicine and integrative health services. Our suite of services support health plans, employers, health systems and providers nationwide as they seek to reduce costs and improve health outcomes. Learn more at TivityHealth. 

Tivity Health is an equal employment opportunity employer and is committed to a proactive program of diversity development.  Tivity Health will continue to recruit, hire, train, and promote into all job levels without regard to race, religion, gender, marital status, familial status, national origin, age, mental or physical disability, sexual orientation, gender identity, source of income, or veteran status.