Hi,
Hope you are doing well.
We do have a position for Healthcare Payer Enterprise Architect with our client. Please find the details below and if interested please send me your updated word format resume.
Tittle: Healthcare Payer Enterprise Architect
Location: Newark, NJ
Duration: Fulltime
Experience : 10-25 Years
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:
o Claims systems, eligibility, benefits, provider workflows.
o Integration frameworks and healthcare data standards.
- Proven expertise in TOGAF or equivalent EA framework.
- Experience in cloud (AWS/Azure/Google Cloud Platform), 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:
o Claims adjudication
o Enrolment & eligibility
o Provider network & contracting
o Care management & utilization
- Payer Domain Transformation
- Architect end-to-end solutions integrating core admin platforms (Facets, QNXT, Health Edge) 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
- AI & Digital Innovation (Preferred / Differentiator)
- Identify and implement AI/ML/GenAI use cases across payer operations such as:
o Claims automation and adjudication
o Fraud, waste & abuse detection
o Member engagement and care insights
- Define AI architecture patterns including:
o Data pipelines, MLOps, and model governance.
- Partner with business stakeholders to translate AI opportunities into scalable solutions.
- Architecture Governance & Leadership
- 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.
- 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.
Bhakti Chaudhari
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