DOMAIN CONSULTANT L4

Job Description Claims SME Required Functional Expertise Claims Processing Professional (CMS-1500)Institutional (UB-04)DentalPharmacy Adjudication & Pricing Claims validation and adjudicationBenefit determinationProvider reimbursement methodologiesFee schedulesDRG, APC, RVU, Percent-of-Charge, Case RatesPayment integrity and claim editing Regulatory Knowledge Medicare AdvantageMedicaidCommercial Health PlansCMS regulationsHIPAA 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.