Head of Provider Operations, TRICARE Oversees Program

Job description

Essential Job Duties and Responsibilities: The Head of Provider Operations leads the operational delivery and performance of provider-facing and provider-enabling services for TOP. This role is accountable for day-to-day execution, controls, and continuous improvement across Claims operations (including governance of the WPS vendor and internal claims team coordination), credentialing and provider data integrity (NSS), and provider support services (TPSS). The role builds and enforces operational KPI frameworks (where gaps exist), establishes disciplined performance management cadences, and ensures audit readiness through robust process controls, documentation completeness, and data quality. The Head of Provider Operations works in close partnership with the Provider Network Director and PNMs to reduce friction for providers, improve right-first-time outcomes, and meet contractual obligations and measurable outcomes. Key Responsibilities: Operational Leadership & Delivery Excellence: Claims Operations Leadership & Vendor Governance (WPS) Credentialing Operations & Provider Data Integrity (NSS) - Define and maintain an effective operational structure for provider operations (Claims,...