DOMAIN CONSULTANT L4

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.

Claims SME

Required Functional Expertise

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

• Medicare Advantage
• Medicaid
• Commercial Health Plans
• CMS regulations
• HIPAA X12 transactions (837, 835, 270/271)

Qualifications

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

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

Mandatory Skills: AI Native IHS . Experience: >10 YEARS .The expected compensation for this role ranges from $100,000 to $200,000 . Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options. Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law. Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome. Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention.