Healthcare Payer Enterprise Architect

Job description

Must Have Technical/Functional Skills

• 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 in cloud (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

Roles & Responsibilities Enterprise & Solution Architecture

• 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 ________________________________________ 2.

Payer Domain Transformation

• Architect end-to-end solutions integrating core admin platforms (Facets, QNXT, HealthEdge) and digital ecosystems
• 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 ________________________________________ 3. AI & Digital Innovation (Preferred / Differentiator)
• 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 ________________________________________ 4.

Architecture Governance & Leadership

• Establish architecture standa rds, 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 ________________________________________ 5. Strategy, Roadmap & Stakeholder Engagement
• 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 Generic Managerial Skills, If any
• 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 Salary Range

• $130,000- $150,000 a year TCS Employee Benefits Summary: 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 & amp; Training Reimbursement.

Time Off

Vacation, Time Off, Sick Leave & Holidays.

Legal & Financial Assistance

Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing. #LI-SP1 </div

Qualifications

BACHELOR OF COMPUTER SCIENCE