Timothy Willson
Dade City,United States
Summary
Healthcare Operations, Revenue Cycle, and Contact Center Leader with 15+ years of experience in Medicaid and Medicare Managed Care and Contact Center environments. Expertise in Reconciliation Operations, Provider Claims Escalations, High-Volume Contact Center Management, Financial Accuracy Validation, and Vendor Oversight. Proven track record of driving SLA and KPI performance, improving quality metrics, and reducing claims escalations through workflow optimization, operational redesign, and performance management initiatives.
Overview
2027
2027
years of professional experience
Work History
Operations Manager – Reconciliation
Wipro
03.2023 - Current
- Directed healthcare reconciliation and production operations supporting Medicaid and Medicare Managed Care lines of business.
- Led multi-layered operational structure including 3 Operations Managers, 4 SMEs, and 47 production agents within reconciliation and claims support functions.
- Managed high-volume Claims and Enrollment Reconciliation processes, ensuring financial accuracy, discrepancy resolution, and SLA compliance.
- Oversaw Provider Claims Escalations team including leadership and frontline agents responsible for complex issue resolution.
- Reduced claims escalations by 60% through implementation of real-time discrepancy resolution workflows and cross-functional process redesign.
- Conducted root cause analysis on reconciliation variances, enrollment discrepancies, and payment mismatches; implemented corrective action plans to improve quality and accuracy metrics.
- Monitored and reported on KPIs including turnaround time, productivity, quality scores, and adherence to service level agreements.
- Ensured compliance with CMS regulations, Medicaid and Medicare guidelines, and internal audit requirements.
- Managed offshore vendor performance, governance standards, and quality assurance oversight across global teams.
- Partnered with Finance, IT, Compliance, and Business Operations to support automation initiatives and AI-driven reconciliation improvements.
- Led workforce planning, performance management, coaching, and leadership development across reconciliation and escalation teams.
Operations Manager; Provider Claims Escalations
Wellcare Health Plans
- Led high-volume Provider Claims Escalations operations supporting Medicaid and Medicare Managed Care lines of business.
- Directed layered team structure including 3 Supervisors, 3 Team Leads, and 42 frontline agents within SLA-driven contact center and back-office environments.
- Managed complex provider escalations lifecycle including intake, investigation, root cause analysis, and resolution within regulatory turnaround requirements.
- Improved claims adjudication accuracy and reduced escalation volume through process redesign and workflow standardization.
- Conducted trend and data analysis on operational error reports to identify systemic issues and implement corrective action plans.
- Ensured compliance with CMS regulations, state Medicaid guidelines, and internal audit standards.
- Partnered cross-functionally with Compliance, IT, Enrollment, and Claims departments to drive operational alignment and issue resolution.
- Recognized by senior leadership for subject matter expertise and requested to return to lead the Escalations team.
Operations Manager; Operations Support Team
Wellcare Health Plans
- Oversaw Operations Support Team including Senior Support Specialists and Operations Support Specialists aligned to Provider Escalations and offshore vendor teams.
- Led knowledge management transformation initiative, standardizing escalation procedures and migrating documentation into enterprise knowledge management platform.
- Conducted 450+ monthly quality and contract audits ensuring compliance with regulatory standards and internal quality methodology.
- Managed vendor governance, offshore coordination, and quality oversight to ensure SLA adherence and performance improvement.
- Supported enterprise system implementations, process automation efforts, and operational technology upgrades.
- Developed and delivered training initiatives, policy updates, and process documentation to improve operational consistency and productivity.
Operations Supervisor; Authorization Intake
Wellcare Health Plans
- Managed contact center team including Team Lead and 16 agents responsible for member authorizations and insurance verification.
- Oversaw daily authorization operations ensuring SLA compliance, productivity standards, and quality performance metrics.
- Monitored real-time adherence, workforce performance, and operational KPIs to maintain service levels.
- Coordinated cross-departmental collaboration to resolve provider and member issues efficiently.
- Ensured compliance with regulatory guidelines and internal performance standards.
Operations Manager; Quality / Contract Audit (Billing and Enrollment)
Wellcare Health Plans
- Directed Quality and Contract Audit operations supporting Billing and Enrollment functions across Medicaid and Medicare lines of business.
- Led audit team responsible for 450+ monthly audits, ensuring adherence to CMS guidelines, regulatory standards, and internal audit methodology.
- Established audit criteria and quality governance standards to improve compliance, accuracy, and process consistency.
- Delivered executive-level audit reporting, trend analysis, and corrective action recommendations to senior leadership.
- Oversaw recruitment, onboarding, performance management, and development of audit staff.
- Drove cross-departmental collaboration to remediate findings and strengthen operational controls.
Operations Manager; Cigna Billing and Enrollment
HealthPlan Services
12.2008 - 03.2015
- Directed enterprise Billing and Enrollment Contact Center operations supporting national health plan clients.
- Managed multi-layered team structure including 3 Supervisors, 3 Team Leads, and 70+ associates.
- Oversaw call center performance metrics including SLA adherence, AHT, quality assurance, productivity, and workforce management.
- Led enterprise-wide phone system integration initiative across cross-functional teams.
- Managed high-level presidential and CMS escalations requiring executive coordination and regulatory expertise.
- Ensured compliance with state and federal healthcare regulations across billing and enrollment operations.
- Drove recruitment, training, leadership development, and performance coaching initiatives.
Education
Camden Sr High
Camden, NYSkills
- Healthcare Operations Management Revenue Cycle Operations Contact Center Operations Performance Management Claims & Enrollment Reconciliation Medicaid & Medicare Managed Care Provider Claims Escalations Financial Accuracy Validation CMS Compliance SLA & KPI Management Vendor & Offshore Operations Root Cause Analysis Process Improvement & Automation Quality Assurance Audit Readiness Cross-Functional Leadership
Timeline
Operations Manager – Reconciliation
Wipro
03.2023 - Current
Operations Manager; Cigna Billing and Enrollment
HealthPlan Services
12.2008 - 03.2015
Operations Manager; Provider Claims Escalations
Wellcare Health Plans
Operations Manager; Operations Support Team
Wellcare Health Plans
Operations Supervisor; Authorization Intake
Wellcare Health Plans
Operations Manager; Quality / Contract Audit (Billing and Enrollment)
Wellcare Health Plans
Camden Sr High