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We are seeking an elite Senior Healthcare Payer Solutions Architect & Strategy Consultant to define our technology vision, select best-in-class tools, and create multi-year roadmaps that drive operational excellence, data integration, and regulatory compliance across the healthcare payer ecosystem. This role combines strategic consulting with deep architectural expertise, ensuring that technology investments align with business objectives, industry regulations, and emerging market trends.
Key Responsibilities:
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Lead the evaluation and selection of technical tools, platforms, and vendors across core payer domains: claims processing, provider network management, care management, member engagement, and analytics.
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Develop comprehensive technology roadmaps that balance innovation, scalability, cost efficiency, and compliance with payer-specific regulations (HIPAA, CMS, NCQA).
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Architect end-to-end solutions that integrate core administration systems (e.g., Facets, QNXT, HealthEdge) with data warehouses, analytics platforms, and digital engagement tools.
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Design interoperability frameworks leveraging industry standards (FHIR, HL7, EDI X12) to enable seamless data exchange across payers, providers, and regulatory agencies.
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Assess existing technology environments, identify modernization opportunities, and recommend cloud migration, API-first, and microservices-based approaches where applicable.
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Partner with executives and business leaders to translate business strategy into scalable, secure, and compliant architectures.
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Ensure architecture governance, technical best practices, and performance benchmarks are met across projects.
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Provide thought leadership on emerging technologies such as AI-driven claims adjudication, predictive analytics for population health, and automation in provider and member workflows.
Required Skills:
- 3+ years in healthcare payer technology roles, including architect-level design and strategic consulting experience.
- Strong understanding of Medicaid/Medicaid terminology
- Proven success in tool/vendor selection, roadmap creation, and solution architecture for payer organizations.
- Deep knowledge of payer operations, regulatory requirements, and healthcare data standards.
- Hands-on experience with core administration platforms (e.g., Facets, QNXT, HealthEdge), enterprise integration tools, and cloud technologies (AWS, Azure, GCP).
- Strong understanding of enterprise architecture frameworks (TOGAF, Zachman) and modern architectural patterns (microservices, event-driven, API-first).
- Excellent leadership, communication, and stakeholder engagement skills.
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