Global Claims & Provider Operations Leader

International SOS; San Antonio (TX); On-site; USD 190,000 - 240,000; Full time

Job summary

International SOS is seeking a Director of Claims Operations to lead the operational delivery for the Tricare Overseas Program, overseeing claims, NSS, and TPSS functions across regions. You will establish KPI frameworks, governance with the WPS vendor, and data-quality controls to reduce friction and improve right-first-time outcomes.

In this global leadership role, you will partner with the Provider Network Director and PNMs to ensure audit readiness, effective provider education, and

Qualifications

• Strong knowledge of provider operations: credentialing controls, data governance, audit readiness, provider support services, and claims operational interfaces.
• Deep expertise in medical and healthcare claims processing, with hands-on experience in shaping and governing payment policy.
• Demonstrated operational excellence: process standardization, KPI management, and continuous improvement.
• Vendor management expertise: governance model, SLA/KPI frameworks, performance improvement, escalation management.

Responsibilities

• Define and maintain an effective operational structure for provider operations (Claims, NSS, TPSS).
• Lead managers to deliver consistent operational execution across regions and time zones.
• Establish standard work, capacity planning, and workload management to stabilize performance.
• Own operational management of the Claims vendor (WPS): governance cadence, SLAs/KPIs, issue management, and continuous improvement plans.
• Coordinate internal Claims team interface with WPS for clear handoffs and timely resolution of issues.
• Operate escalation pathways for complex claims/billing issues and ensure proper routing for fraud-related pathways.
• Partner with Provider Network Director/PNMs and TPSS to improve education and data quality for timely claim processing.
• Own on-time and in-full claims reimbursement and implement countermeasures to meet KPIs.
• Own credentialing throughput and data integrity aligned to standards; ensure audit readiness.
• Implement quality assurance routines to address defects and prevent downstream failures.
• Ensure TPSS delivers efficient provider support, education, and clear escalation processes.
• Drive KPI systems and dashboards to enable corrective actions and continuous improvement.
• Maintain documentation and decision rights in partnership with governance.

Skills

Provider operations

Credentialing

Data governance

KPI management

Vendor management

Analytical skills

Leadership

Communication

Cross-functional leadership

Education

Bachelor's degree in business, Healthcare Management, Operations, or related field

Master’s degree or equivalent qualification strongly preferred

Job description

International SOS is seeking a Director of Claims Operations to lead the operational delivery for the Tricare Overseas Program, overseeing claims, NSS, and TPSS functions across regions. You will establish KPI frameworks, governance with the WPS vendor, and data-quality controls to reduce friction and improve right-first-time outcomes.

In this global leadership role, you will partner with the Provider Network Director and PNMs to ensure audit readiness, effective provider education, and