Job Description:
Our client is seeking a Payer Solution Architect to design and deliver scalable, business-aligned technology solutions for health plan clients. This role bridges business architecture, systems, data, and delivery, translating complex payer requirements into practical solution designs.
The ideal candidate brings deep expertise in the U.S. healthcare payer ecosystem (Medicaid, Medicare Advantage, Commercial, ACA) and understands how platforms, data, integrations, and operations work together.
Key Responsibilities:
Solution Architecture & Strategy:
- Design end-to-end solutions across payer operations (claims, enrollment, billing, provider, care management, digital, analytics)
- Translate business needs into scalable architecture and implementation roadmaps
- Define current/future state architectures and evaluate solution options, risks, and tradeoffs
Payer Platform & Domain Expertise:
- Provide expertise across core admin platforms (Facets, QNXT, HealthRules, ika)
- Work with CRM (Salesforce), care management (GuidingCare, Jiva), and data platforms
- Design solutions accounting for payer complexities (claims, eligibility, benefits, risk adjustment, regulatory reporting)
Integration & Data Architecture:
- Define integrations using APIs, EDI, HL7/FHIR, batch, and event-driven patterns
- Support data flow design, data models, and data quality controls across key domains (member, provider, claims, clinical, financial)
Delivery Leadership:
- Guide cross-functional teams (BA, Dev, Data, QA, vendors) through design and delivery
- Identify risks, dependencies, and ensure alignment across workstreams
- Support planning, estimation, governance, and implementation execution
Client Advisory:
- Act as a trusted advisor to business and technology stakeholders
- Lead workshops and communicate complex concepts in business terms
- Support pre-sales, solutioning, and client engagements
Required Qualifications:
- 8+ years in payer technology, solution architecture, or consulting
- Strong knowledge of health plan operations (claims, enrollment, billing, care management, etc.)
- Experience with payer platforms, integrations, data architecture, or digital transformation
- Familiarity with EDI transactions, interoperability standards, and payer data domains
- Proven ability to translate business requirements into architecture designs and roadmaps
- Strong stakeholder management and communication skills
Preferred Qualifications:
- Experience with Facets, QNXT, HealthRules, or similar platforms
- Exposure to Salesforce Health Cloud / Service Cloud
- Knowledge of CMS, Medicare/Medicaid, ACA, risk adjustment, HEDIS, Stars
- Experience with cloud platforms (AWS, Azure, Google Cloud Platform; Snowflake, Databricks)
- Familiarity with integration tools (MuleSoft, Boomi, Informatica) and standards (FHIR, HL7, X12)
- Consulting experience with healthcare payer clients
Rate: $75-$95/hour (depends on experience level). This is a contract position with candidates expected to work 40 hours/ week.
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