Domain Consultant L4

Wipro • Jefferson City, MO

6h

About The Position

Wipro Limited is a leading technology services and consulting company focused on building innovative solutions that address clients’ most complex digital transformation needs. Leveraging its holistic portfolio of capabilities in consulting, design, engineering, and operations, Wipro helps clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, Wipro delivers on the promise of helping its customers, colleagues, and communities thrive in an ever-changing world. This role requires a Claims SME with required functional expertise in 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 including Medicare Advantage, Medicaid, Commercial Health Plans, CMS regulations, HIPAA, and X12 transactions (837, 835, 270/271) is also essential. The role involves bridging business operations and product engineering teams and familiarity with configurable rules engines, workflow-driven applications, and AI-assisted modernization is desired. Experience working across Medicare, Medicaid, and Commercial Lines of Business is required.

Requirements

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

Nice To Haves

• Familiarity with configurable rules engines, workflow-driven applications, and AI-assisted modernization.

Responsibilities

• 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
• Medicare Advantage
• Medicaid
• Commercial Health Plans
• CMS regulations
• HIPAA
• X12 transactions (837, 835, 270/271)
• Bridging business operations and product engineering teams
• Working on claims platform implementations, enhancements, or modernization initiatives

Benefits

• Full range of medical and dental benefits options
• Disability insurance
• Paid time off (inclusive of sick leave)
• Other paid and unpaid leave options

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed