TPA Operations Leader: Claims, Compliance & Delivery

Wipro; Tampa (FL); On-site; USD 200,000 - 280,000; Full time

Benefits offered by this job

Medical and dental benefits

Disability insurance

Paid time off

Job summary

Wipro seeks a senior leader to head TPA Operations, owning end-to-end health insurance claims delivery, payment integrity, and provider data management. The role demands strategic regulatory foresight, internal controls, and proactive client partnership across multiple lines of business.

The ideal candidate brings 10–15 years in payor operations with at least 5 in senior leadership, and a track record of improving efficiency and compliance within a TPA environment. Competitive benefits apply.

Qualifications

• Bachelor’s degree in a related field; Master’s preferred.
• Minimum 10–15 years in health insurance payor operations with 5+ years in senior leadership overseeing TPA functions.
• Experience across ASO, fully insured, and government programs (e.g., Medicare, ACA).

Responsibilities

• Oversee day-to-day TPA operations including claims processing and payment integrity.
• Own reporting, data generation, and tax filings with an operational calendar.
• Monitor federal/state regulatory obligations (HIPAA, ERISA, CMS) and ensure compliance.
• Direct provider data management, contracts, and fee schedules.
• Lead payment integrity efforts including FWA detection and recovery.
• Serve as key client contact for claims operations and strategic guidance.

Skills

Leadership

Regulatory expertise

Client management

Communication

Problem-solving

Education

Bachelor’s degree

Master’s degree preferred

Tools

TPA systems

Job description

Wipro seeks a senior leader to head TPA Operations, owning end-to-end health insurance claims delivery, payment integrity, and provider data management. The role demands strategic regulatory foresight, internal controls, and proactive client partnership across multiple lines of business.

The ideal candidate brings 10–15 years in payor operations with at least 5 in senior leadership, and a track record of improving efficiency and compliance within a TPA environment. Competitive benefits apply.