Healthcare Payer Enterprise Architect

Qualifications

• 12+ years in IT with 5+ years in enterprise/solution architecture
• Strong experience in U.S Healthcare Payer domain
• Hands‑on knowledge of Claims systems, eligibility, benefits, provider workflows
• Integration frameworks and healthcare data standards
• Proven expertise in TOGAF or equivalent EA framework
• Experience with cloud platforms (AWS, Azure, GCP), APIs, microservices and data architecture
• Strong stakeholder management and communication skills
• Experience with AI‑driven utilization management / prior authorization
• Knowledge of payer cost‑of‑care optimization and analytics
• Exposure to GenAI‑based SDLC / automation frameworks
• Strategic thinker with strong business‑to‑technology alignment capability
• Ability to drive large‑scale transformation programs
• Strong consulting mindset with stakeholder influence
• Mentoring and leading cross‑functional architecture teams

• Define and govern enterprise architecture using TOGAF principles and frameworks
• Develop current‑state, target‑state, and transformation roadmaps across payer systems
• Lead architecture design across core payer domains:
  Claims adjudication, Enrollment & eligibility, Provider network & contracting, Care management & utilization
• Ensure compliance with payer regulations (HIPAA, CMS, NCQA)
• Drive interoperability using HL7, FHIR, EDI X12 standards
• Evaluate modernization opportunities including API‑first, microservices, and cloud adoption
• Identify and implement AI/ML/GenAI use cases across payer operations such as Claims automation and adjudication, fraud, waste & abuse detection, member engagement and care insights
• Define AI architecture patterns including data pipelines, MLOps, and model governance
• Partner with business stakeholders to translate AI opportunities into scalable solutions
• Establish architecture standards; patterns, and governance frameworks
• Lead architecture review boards and ensure design compliance
• Collaborate with business, engineering, and product teams for aligned delivery
• Act as trusted advisor to C‑level / client leadership on technology strategy
• Translate business strategy into technology architecture blueprints
• Define multi‑year digital transformation and AI adoption roadmap
• Engage cross‑functional stakeholders across IT, operations, and vendor ecosystem

$130,000 – $150,000 a year

• Discretionary Annual Incentive
• Comprehensive Medical Coverage:
  Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans
• Family Support:
  Maternal & Parental Leaves
• Insurance Options:
  Auto & Home Insurance, Identity Theft Protection
• Convenience & Professional Growth:
  Commuter Benefits & Certification & Training Reimbursement
• Time Off:
  Vacation, Time Off, Sick Leave & Holidays
• Legal & Financial Assistance:
  Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing

BACHELOR OF COMPUTER SCIENCE