Service Delivery Head, Claims BPaaS DeliveryService Delivery Head, Claims BPaaS Delivery
- Work mode
- On-site
- Employment type
- Full-time
About the job
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.
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From Wipro's careers page (Company careers page), checked 31 Oct 2026.
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Posted · checked 31 Oct 2026 · Report this job