DOMAIN CONSULTANT L4

Wipro; Jefferson City (MO); On-site; USD 100,000 - 200,000; Full time

Benefits offered by this job

Medical and dental benefits

Disability insurance

Paid time off

Job summary

Wipro Limited is seeking an experienced Claims SME with deep knowledge of Medicare, Medicaid, and Commercial Lines. The role focuses on adjudication, pricing, and regulatory compliance for payer claims processing across CMS guidelines.

The candidate will support AI-enabled modernization efforts, collaborate with business operations and product engineering teams, and drive improvements in claims platform implementations while ensuring quality and stakeholder alignment.

Qualifications

• 10+ years of healthcare payer claims domain experience.
• 10+ years of Business Analysis, Systems Analysis, or Product Analysis experience.
• Strong communication, facilitation, and stakeholder management skills.
• Ability to bridge business operations and product engineering teams.
• Familiarity with configurable rules engines, workflow-driven applications, and AI-assisted modernization.

Responsibilities

• Experience working on claims platform implementations, enhancements, or modernization initiatives.
• Experience working across Medicare, Medicaid, and Commercial Lines of Business.
• Understand payer operations and claim adjudication workflows.
• Adherence to CMS regulations and HIPAA X12 transactions (837, 835, 270/271).

Skills

Healthcare claims

Business Analysis

Stakeholder mgmt

Communication

Cross-team collaboration

Job description

Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com.

Job Description:

Claims SME

Required Functional Expertise

Claims Processing

• Professional (CMS-1500)
• Institutional (UB-04)
• Dental
• Pharmacy

Adjudication & Pricing

• Claims validation and adjudication
• Benefit determination
• Provider reimbursement methodologies
• Fee schedules
• DRG, APC, RVU, Percent-of-Charge, Case Rates
• Payment integrity and claim editing

Regulatory Knowledge

• Medicare Advantage
• Medicaid
• Commercial Health Plans
• CMS regulations
• HIPAA X12 transactions (837, 835, 270/271)

Qualifications

• 10+ years of healthcare payer claims domain experience.
• 10+ years of Business Analysis, Systems Analysis, or Product Analysis experience.
• Deep understanding of healthcare claims adjudication platforms and payer operations.
• Experience working on claims platform implementations, enhancements, or modernization initiatives.
• Strong communication, facilitation, and stakeholder management skills.
• Ability to bridge business operations and product engineering teams.
• Familiarity with configurable rules engines, workflow-driven applications, and AI-assisted modernization.

• Experience working across Medicare, Medicaid, and Commercial Lines of Business.

Mandatory Skills: AI Native IHS.Experience: >10 YEARS.

The expected compensation for this role ranges from $100,000 to $200,000 .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.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, caste, creed, religion, gender, marital status, age, ethnic and national origin, gender identity, gender expression, sexual orientation, political orientation, disability status, protected veteran status, or any other characteristic protected by law.

Wipro is committed to creating an accessible, supportive, and inclusive workplace. Reasonable accommodation will be provided to all applicants including persons with disabilities, throughout the recruitment and selection process. Accommodations must be communicated in advance of the application, where possible, and will be reviewed on an individual basis. Wipro provides equal opportunities to all and values diversity.