Domain Expert - SME Healthcare Claims

Wipro Technologies; Jefferson City (MO); On-site; USD 100,000 - 150,000; Full time

Job summary

Wipro Technologies is seeking a skilled Domain Expert in US Healthcare Claims to lead initiatives in claims management. The role requires strong expertise in processing and adjudication with a focus on data analysis and technology. Candidates should have a bachelor's degree and at least 15 years of relevant experience, delivering actionable insights and ensuring compliance in an innovative setting.

Qualifications

• Minimum of 15 years in healthcare claims management.
• Expertise in claims adjudication, coding, and billing practices.
• Proficient in claims processing software.

Responsibilities

• Act as primary contact for healthcare claims processes.
• Provide strategic insights into claims management.
• Collaborate with teams to optimize claims processing systems.

Skills

Healthcare claims management

Data analysis

Project management

Process improvement

Education

Bachelor's degree in Healthcare Administration, IT, or related field

Advanced degree preferred

Tools

FACETS

HealthEdge

Plexis

Job description

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Requisition ID: 68360

City: Jefferson City

Country/Region: US

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

Job Title : Domain Expert (Subject Matter Expert) in Healthcare Claims to drive Claims practice

USA

Job Summary: We are seeking a highly skilled and knowledgeable Domain Expert (Subject Matter Expert) in US Healthcare Claims with profound expertise in both process and technology. This role demands a deep understanding of healthcare claims management, including the intricacies of processing, adjudication, and the technological frameworks that support these activities.

Key Responsibilities:

• Act as the primary point of contact and expertise in healthcare claims processes and technologies.
• Provide strategic insights into healthcare claims management, identifying areas for improvement and innovation.
• Collaborate with cross-functional teams to design, implement, and optimize claims processing systems.
• Analyze and interpret complex data related to healthcare claims to provide actionable recommendations.
• Ensure compliance with relevant regulations and standards within the healthcare claims domain.
• Stay abreast of industry trends, emerging technologies, and regulatory changes affecting healthcare claims.
• Assist in the evaluation and selection of technology/platform solutions that improve healthcare claims processing efficiency.
• Working knowledge with various claims platforms such as FACETS, HealthEdge, Plexis, etc.
• Lead AI and GenAI transformation initiatives to enhance healthcare claims processes.

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Qualifications

• Bachelor's degree in Healthcare Administration, IT, or a related field; advanced degree preferred.
• Minimum of 15 years of experience in healthcare claims management, with a focus on process and technology.
• Strong understanding of healthcare claims adjudication, coding, and billing practices.
• Proficiency in healthcare claims processing software and systems.
• Excellent analytical skills, capable of interpreting complex data sets and generating insights.
• Proven ability to manage multiple projects and deadlines effectively.

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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.