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Health Insurance Tpa Jobs in Florida (NOW HIRING)

Wipro Limited

Head of TPA Operations & Delivery

Tampa, FL · On-site

$200K - $280K/yr

The ideal candidate will have deep expertise in health insurance payor operations and a proven track record of driving efficiency, accuracy, and proactive compliance in a TPA environment. Essential ...

VUMI Group

Director of TPA Relations

Miami, FL · On-site

POSITION SUMMARY The Director of TPA Relations is responsible for overseeing and optimizing the ... global health insurance, international assistance, or travel/expat medical programs. * Direct ...

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Health Insurance Tpa information

What is a health insurance TPA?

Health Insurance TPAs, or Third Party Administrators, are organizations that process insurance claims or certain aspects of employee benefit plans for health insurance companies. They act as intermediaries between insurance providers, policyholders, and healthcare providers, ensuring that claims are processed efficiently and in accordance with policy terms. TPAs handle tasks such as claim adjudication, customer service, network management, and sometimes even policy administration. Their main role is to streamline operations for insurance companies and improve the experience for policyholders.

What are the key skills and qualifications needed to thrive as a health insurance TPA?

To excel as a Health Insurance TPA, you need a solid understanding of health insurance policies, claims processing, and regulatory compliance, often backed by a relevant degree in insurance, business, or healthcare administration. Familiarity with claims management software, policy administration systems, and industry certifications such as HIPAA compliance are typically required. Strong attention to detail, problem-solving abilities, and effective communication skills help build trust with clients and resolve issues efficiently. These competencies ensure accurate and timely claims processing, regulatory adherence, and high-quality customer service in a complex healthcare environment.

How does a health insurance TPA typically interact with insurance companies and healthcare providers on a daily basis?

A Health Insurance Third Party Administrator (TPA) acts as an intermediary between insurance companies, policyholders, and healthcare providers. On a daily basis, TPAs process insurance claims, coordinate with hospitals for cashless treatments, and verify documentation to ensure smooth claim settlements. They frequently communicate with insurers to clarify policy terms and resolve discrepancies, while also assisting healthcare providers in understanding claim requirements. This collaborative approach requires strong organizational and communication skills, as well as attention to detail.

What is the difference between Health Insurance Tpa vs Health Insurance Claims Processor?

AspectHealth Insurance TpaHealth Insurance Claims Processor
RoleManages claims, customer service, and policy administration on behalf of insurersProcesses individual insurance claims, verifies documents, and approves or rejects claims
CredentialsTypically requires insurance or TPA-specific certificationsOften requires basic insurance knowledge and claims processing training
Work EnvironmentOffice-based, interacting with clients, insurers, and healthcare providersOffice or remote, focusing on data entry and claim verification
Industry UsageCommonly employed by third-party administrators in health insuranceUsed within insurance companies or third-party claims teams

In summary, a Health Insurance Tpa oversees claims management and customer service for insurers, while a Health Insurance Claims Processor focuses on the detailed processing and verification of individual claims. Both roles are essential in the health insurance industry but differ in scope and responsibilities.

What are popular job titles related to Health Insurance Tpa jobs in Florida?

For Health Insurance Tpa jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Health Insurance Tpa jobs in Florida look for?

The top searched job categories for Health Insurance Tpa jobs in Florida are:

Health Insurance Tpa jobs near you
Infographic showing various Health Insurance Tpa job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Head of TPA Operations & Delivery

Wipro Limited

Tampa, FL • On-site

$200K - $280K/yr

Full-time

Medical, Dental, PTO

Re-posted 18 hours ago

Wipro rating

7.2

Company rating: 7.2 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

138th of 226 rated it services

Job description

Job Title: Head of TPA Operations & Delivery
City: Tampa
State/Province: Florida
Posting Start Date: 7/2/26
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.
Job Description:
Job Description
The Head of TPA Operations is a senior, hands-on leader responsible for the end-to-end delivery of health insurance claims services. This role assumes ultimate ownership for the entire lifecycle of claims and adjacent TPA functions, including payment integrity, provider data management, and all associated regulatory and financial reporting. The ideal candidate will have deep expertise in health insurance payor operations and a proven track record of driving efficiency, accuracy, and proactive compliance in a TPA environment.
Essential Duties and Responsibilities
  • Operational Leadership & Delivery:
    • Oversee all day-to-day TPA operations, including claims processing, payment integrity, and provider data management, ensuring timely, accurate, and compliant delivery across all lines of business.
    • Assume ultimate ownership for ensuring that all operational activities, including all necessary reporting, data generation, and tax filings, are performed accurately and on time. Develop and maintain a comprehensive operational calendar to track and manage all deliverables and deadlines.
  • Regulatory Foresight and Strategy:
    • Act as the primary subject matter expert on all TPA-related operational and regulatory obligations. Proactively monitor, interpret, and implement the full spectrum of federal and state requirements, including federal and state data transparency mandates, all required tax and financial reporting obligations, ERISA, and HIPAA.
  • Payment Integrity:
    • Lead and oversee all payment integrity functions, including fraud, waste, and abuse (FWA) detection, prevention, and recovery efforts.
    • Develop and implement strategies to enhance payment accuracy and reduce claim overpayments.

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  • Provider Data Management:
    • Direct the management of provider data, ensuring accuracy and timeliness of provider credentialing and demographic information.
    • Oversee the implementation of new provider contracts and fee schedules.
  • Compliance & Reporting:
    • Ensure all processes and procedures are fully compliant with all applicable healthcare regulations, including HIPAA, ERISA, and CMS guidelines, with a strong focus on claims-related compliance.
    • Establish and maintain robust internal controls and auditing procedures to ensure operational and regulatory integrity.
  • Strategic Planning & Client Management:
    • Partner with senior leadership to develop and execute the strategic vision for the TPA claims function.
    • Serve as the key point of contact for clients on all matters related to claims operations, providing expert guidance and ensuring high levels of client satisfaction.

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Education and Experience
  • Bachelor's degree in Business Administration, Health Administration, or a related field required; Master's degree preferred.
  • Minimum of 10-15 years of progressive experience in health insurance payor operations, with at least 5 years in a senior leadership role overseeing TPA functions.
  • Demonstrated, hands-on experience managing the full scope of TPA responsibilities across multiple, complex lines of business, including ASO, fully insured, and government programs (e.g., Medicare, ACA).
  • Proven track record of ensuring timely and accurate filing of all required regulatory data submissions and all financial/tax-related reporting.
  • Demonstrated experience managing payment integrity functions, including FWA programs.
  • Proven experience with provider data management processes within a TPA or health plan environment.
  • In-depth knowledge of claims processing systems, industry best practices, and relevant federal and state regulations.
  • Exceptional leadership, communication, and problem-solving skills.

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The expected compensation for this role ranges from $200,000.00 to $280,000.00.
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.

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