Head of Provider Operations, TRICARE Oversees Program

Head Of Provider Operations

At International SOS, we are in the business of protecting and saving lives. For 40 years, we have delivered customized security risk management, health, and wellbeing solutions to organizations worldwide. With a presence in 90 countries and a team of nearly 13,000 experts, we provide 24/7 support to help organizations fulfill their Duty of Care responsibilities.

Now, we're looking for talented individuals to join our team and make a difference.

Purpose of the Job:

The Head of Provider Operations leads the operational delivery and performance of provider-facing and provider-enabling services for Tricare Overseas Program. 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
  • Define and maintain an effective operational structure for provider operations (Claims, NSS, TPSS), including roles, span of control, escalation pathways, and coverage plans.
• Claims Operations Leadership & Vendor Governance (WPS)
  • Own operational management of the Claims vendor (WPS): governance cadence, SLAs/KPIs, issue management, root-cause elimination, and continuous improvement plans.
• Credentialing Operations & Provider Data Integrity (NSS)
  • Own credentialing throughput and quality performance: document validation, accreditation tracking, and provider profile integrity (e.g., SPIN data maintenance) aligned to applicable standards.
• Provider Support Services (TPSS) Delivery
  • Ensure TPSS delivers efficient provider support, education, and claims-related service to providers/beneficiaries, including clear escalation processes for billing/claims support issues.
• KPI System Build, Performance Management & Continuous Improvement
  • Translate operational priorities into measurable KPIs (build where absent), define measurement logic, set targets, and cascade accountability across Claims/NSS/TPSS.
• Controls, Compliance & Audit Readiness (Execution Owner)
  • Own readiness for audits and formal reviews by ensuring controls, documentation completeness, and data integrity are consistently met; escalate risks early with clear mitigation plans.

Required Skills and Knowledge
• Strong understanding of provider operations: credentialing controls, data governance, audit readiness, provider support services, and claims operational interfaces.

Required Competencies Strategic Leadership & Decision-Making
• Provides clear direction and sets high standards for global network operations performance.
• Makes prompt, confident decisions under ambiguity, balancing medical priorities with operational feasibility.

Delivering Results & Meeting Customer Expectations
• Maintains relentless focus on contractual KPIs, access-to-care standards, and readiness objectives.
• Monitors and enforces quality and productivity across dispersed teams; drives continuous improvement.

Collaboration, Influencing & Negotiation
• Builds strong relationships with medical leadership, PNMs, and cross-functional partners.
• Gains commitment through persuasion and negotiation; secures alignment among diverse stakeholders.
• Leads difficult conversations with confidence and diplomacy—resolving conflicts, addressing performance gaps, and managing provider or client escalations effectively.

Analytical & Systems Thinking
• Interprets operational and clinical data to identify patterns, root causes, and improvement opportunities.
• Connects tactical issues to strategic objectives; designs scalable solutions for global…