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Location: Remote EST

Duration: Multi year contract

Position Responsibilities:

• 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.
• Develop comprehensive technology roadmaps that balance innovation, scalability, cost efficiency, and compliance with payer-specific regulations (HIPAA, CMS, NCQA).
• Architect end-to-end solutions that integrate core administration systems (e.g., Facets, QNXT, HealthEdge) with data warehouses, analytics platforms, and digital engagement tools.
• Design interoperability frameworks leveraging industry standards (FHIR, HL7, EDI X12) to enable seamless data exchange across payers, providers, and regulatory agencies.
• Assess existing technology environments, identify modernization opportunities, and recommend cloud migration, API-first, and microservices-based approaches where applicable.
• Assess the overarching problems and solutions by listening to the BRD sessions, reading the Business Requirements Documents, and connecting with the BA afterward.
• Be very tactful with soft skills to be respectful working as a team. This is the key piece of this role.
• Partner with executives and business leaders to translate business strategy into scalable, secure, and compliant architectures.
• Ensure architecture governance, technical best practices, and performance benchmarks are met across projects.
• 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:

• 8+ years in healthcare payer technology roles, including architect-level design and strategic consulting experience.
• Hands-on experience with core administration platforms (e.g., Facets, QNXT, HealthEdge), enterprise integration tools, and cloud technologies (AWS, Azure, GCP).
• Cutting Edge technical knowledge: up to date on current applications, vendors, etc.
• Diverse experience across applications of all types - Cloud, Data, Infrastructure, Network - all within health insurance/payers
• Proven success in tool/vendor selection, roadmap creation, and solution architecture for payer organizations.
• Excellent soft skills translating respect - communicate with clients well, speak to the business users
• 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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