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Job Title: Service Delivery Head, Claims BPaaS Delivery
Band: D1
Location: Tampa

Summary

The Service Delivery Head, Claims BPaaS Delivery is a senior, hands-on leader responsible for the end-to-end delivery of health insurance payor claims operations and platform solutions at WHPS. This role requires deep expertise in health insurance payor claims (not provider claims), technology, the broader claims ecosystem—including internal teams, external vendors, and third-party integrations—and the payment integrity lifecycle (claims editing, audit, recovery, and fraud/waste/abuse prevention). In addition to operational excellence, the successful candidate must possess advanced technical acumen, with the ability to architect, evaluate, and troubleshoot complex claims platform solutions, drive automation, and lead technology-enabled transformation initiatives. The Service Delivery Head will serve as a primary client-facing leader, ensuring exceptional service delivery, operational excellence, and compliance. Success in this role requires strategic vision, strong accountability, analytical thinking, business acumen, and the ability to build effective relationships across all levels of staff, clients, and partners. The ideal candidate will have experience with multiple claims platforms, including Beacon SpyGlass, Plexis, and HealthEdge.

Essential Duties and Responsibilities

Operational Leadership & Delivery

• Oversee day-to-day health insurance payor claims operations, ensuring timely, accurate, and compliant processing across all lines of business (ACA, Medicare, Medicaid, Commercial, ASO).
• Lead, motivate, develop, and mentor managers and staff, fostering a culture of accountability, continuous improvement, and hands-on problem solving.
• Be a hands-on leader, actively engaging in the details of claims delivery, issue resolution, and process optimization.

Claims Ecosystem & Vendor Management

• Understand and manage the entire health insurance payor claims ecosystem, including internal teams, external vendors, and third-party partners.
• Oversee integration and ongoing relationships with vendors and third parties, ensuring seamless interoperability and service delivery.
• Proactively identify and address risks, gaps, and opportunities within the claims ecosystem.

Platform & IT Delivery

• Serve as the subject matter expert on health insurance payor claims platforms and related IT systems.
• Oversee the implementation, upgrade, and optimization of claims technology solutions, ensuring alignment with business needs and regulatory requirements.
• Demonstrated expertise in multiple claims administration platforms; direct experience with Beacon SpyGlass, Plexis, and HealthEdge is highly preferred.
• Collaborate with IT and external partners to ensure platform stability, scalability, and integration.
• Lead technical assessments and solution architecture for claims platform enhancements, integrations, and automation opportunities.
• Troubleshoot complex technical issues, partnering with IT and vendors to resolve platform and data challenges.
• Drive the adoption of new technologies, automation tools, and data analytics capabilities to improve operational efficiency and accuracy.
• Ensure robust data security, privacy, and compliance across all technical solutions and integrations.

Payment Integrity Lifecycle

• Lead and oversee the payment integrity lifecycle, including claims editing, pre- and post-payment audits, recovery, and fraud/waste/abuse prevention.
• Ensure payment integrity processes are integrated with claims operations and platform delivery, working closely with internal teams and external vendors.
• Monitor and report on payment integrity metrics, trends, and outcomes to drive continuous improvement and compliance.

Client-Facing Leadership

• Serve as the primary point of contact for clients on all payor claims-related matters, representing WHPS with professionalism and expertise.
• Build and maintain strong relationships with clients, providers, internal departments, vendors, and executive leadership.
• Lead client meetings, presentations, and issue resolution, ensuring high levels of satisfaction and trust.

Compliance & Reporting

• Ensure compliance with state, federal, and industry regulations, including HIPAA and CMS guidelines.
• Prepare and present regular reports on claims performance, payment integrity, trends, and department metrics.
• Conduct audits and reviews to maintain high standards of accuracy and compliance.

Stakeholder Engagement

• Build and maintain effective working relationships and work collaboratively with all levels of staff, clients, vendors, and partners.
• Collaborate with cross-functional teams to optimize processes and systems to support claims operations.

Project Management

• Oversee the implementation of upgrades and new products related to claims systems.
• Facilitate effective inter-departmental communication to ensure the impact of procedural changes and system enhancements are fully understood.
• Prioritize objectives and tasks, set target dates, track project completion, and determine the most effective methods to accomplish project goals.

Skills and Competencies

• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Exceptional time management and organizational skills.
• Ability to develop effective working relationships and work collaboratively with all levels of staff, vendors, and partners.
• Demonstrated ability to lead, motivate, develop, and mentor others.
• Solid business acumen, decision-making, research, and analytical skills.
• Integrity and trust.
• Customer focus.
• Advanced technical expertise in health insurance claims platforms, systems integration, and data management.
• Proficiency in solution architecture, platform evaluation, and technical troubleshooting.
• Experience with automation, process optimization, and technology-enabled transformation initiatives.
• Strong understanding of data security, privacy, and compliance requirements in healthcare technology.
• Written/oral communication.
• Accountability – ability to accept responsibility and account for actions.
• Active listening – ability to attend to, convey, and understand comments and questions of others.
• Autonomy – ability to work independently.
• Creative thinking – ability to generate new concepts and ideas.
• Customer orientation – ability to take care of clients’ needs while following company procedures.
• Detail orientation – ability to pay attention to the minute details of projects and tasks.
• Interpersonal skills – ability to get along well with a variety of personalities and individuals.
• Ability to work under pressure and complete assigned tasks in stressful situations.
• Knowledge of industry best practices and trends.
• Strong negotiation and relationship-building skills.
• Ability to analyze data and make informed decisions.
• Expertise in payment integrity lifecycle, including claims editing, audit, recovery, and fraud/waste/abuse prevention.

Education and Experience

• Bachelor’s Degree in Business Administration, Healthcare Administration, Information Technology, or a related field (Master’s preferred).
• Minimum of 10 years of experience in health insurance payor claims operations, with at least 5 years in a senior leadership role.
• Proven experience managing large, geographically dispersed teams.
• Strong knowledge of health insurance industry, including ACA, Medicare, Medicaid, Commercial, and ASO.
• Extensive experience with multiple health insurance claims platforms; direct experience with Beacon SpyGlass, Plexis, and HealthEdge is highly preferred.
• Deep understanding of claims policies, procedures, regulatory requirements, and industry standards (including HIPAA, CMS, AMA, CCI edits).
• Demonstrated experience managing payment integrity functions within health insurance payor claims operations.
• Experience managing vendor and third-party integrations within the claims ecosystem.
• Significant hands-on experience with technical solution design, platform integration, automation, and data analytics in health insurance claims operations.

The expected compensation for this role ranges from $190,000.00  to $265,000.00.

Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.

Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law.

Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome.

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