AI Lead/AI Architect with Health Insurance experience

Job Title: Lead AI Architect Healthcare & Cloud Platforms

Location: Bloomfield CT - Hybrid

Experience Level: 13+ years

Role Overview:

We are seeking a highly experienced Lead Architect to drive enterprise-grade cloud Generative AI Platform initiatives in the Healthcare Payer and PBM (Pharmacy Benefit Management) space. This role demands a unique combination of technical leadership, domain knowledge, and client-facing communication skills. You will be instrumental in architecting and driving implementation of scalable, secure, and cost-optimized GenAI-powered systems and modern test automation pipelines using cloud services(AWS & Azure)

Key Responsibilities

Lead solution architecture and implementation for healthcare payer clients, with a focus on PBM systems, claims management, benefits configuration, and eligibility workflows.

Design cloud-native generative AI solution platforms on AWS and Azure with an emphasis on performance, scalability, resilience, and cost efficiency.

Serve as a strategic technical advisor in client engagements, translating business requirements into technical solutions.

Architect and drive implementation of GenAI-enabled systems, particularly RAG (Retrieval-Augmented Generation) patterns for knowledge-based services.

Collaborate with product, engineering, UX, and QA teams to embed UX-driven test automation frameworks using Python and JavaScript.

Understand architectural governance, standards, and best practices for multi-region, multi-cloud deployments.

Stay ahead of the curve on regulatory compliance in healthcare (HIPAA, HITRUST), data privacy, and security controls.

Required Skills and Competencies:

Domain Expertise:

• Understanding of the Healthcare Payer ecosystem including claims adjudication, EDI workflows, member/provider systems, and payer-provider data exchange models.
• Proven experience in PBM systems, including formulary management, prior authorization, and medication adherence workflows.
• Cloud and Systems Architecture
• 5+ years of experience in architecting solutions on AWS and/or Azure, with proficiency in:
• IAM, EC2, Lambda, S3, ECS, RDS, Redshift (AWS)
• App Services, Azure Functions, Cosmos DB, Azure DevOps (Azure)
• Familiarity with cost modeling and optimization in cloud environments.
• Strong foundation in microservices, event-driven architecture, and API management.
• Software Engineering and Automation
• Hands-on expertise in Python and JavaScript for platform development and scripting.
• Experience with modern test automation frameworks that are UX-focused (e.g., Cypress, Playwright).
• Ability to drive the design of CI/CD pipelines and integration of quality assurance into release workflows.

Generative AI & Advanced Systems

• Strong knowledge of GenAI platforms, including RAG patterns, vector databases, prompt engineering, and LLM lifecycle management.
• Understanding of how AI can be applied in clinical decision support, prior authorization automation, and member engagement.

Soft Skills

• Strong client-facing communication and stakeholder management capabilities.
• Adept at cross-functional collaboration and leading matrix teams across technology, product, and business groups.
• Thought leadership and mentoring of technical teams.

Preferred Qualifications

• Bachelor s or Master s degree in Computer Science, Engineering, or a related field.
• AWS/Azure certifications (e.g., AWS Solutions Architect Professional, Azure Solutions Architect Expert).
• Experience working with FHIR, HL7, EHR integrations, or healthcare interoperability frameworks.
• Prior involvement in enterprise AI/ML strategy or innovation programs in healthcare.