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Role Summary
Seeking a senior healthcare Solution Architect to lead architecture and solution design for state-specific Medicaid regulatory changes across the health-plan technology ecosystem.
The architect should have deep knowledge of Facets, Mainframe, Java, DataStage, Talend/TalendWorks and healthcare payer architecture, combined with strong Medicaid regulatory and business-process knowledge.
Key Responsibilities
• Own end-to-end technical architecture for state-specific Medicaid regulatory changes.
• Assess regulatory impacts across:
• Facets
• Mainframe platforms
• Java/J2EE applications
• DataStage
• Talend/TalendWorks
• APIs and integration services
• Databases
• Batch platforms
• Upstream and downstream applications
• Determine the appropriate implementation approach across Facets configuration, Mainframe development, Java development, ETL/data changes, integration changes, or surrounding applications.
• Design solutions supporting:
• Member enrollment
• Eligibility
• Benefits
• Claims adjudication
• Claims pricing
• Claims payment
• Regulatory edits
• Medicare/Medicaid coordination
• Develop architecture patterns that allow common capabilities to be reused while supporting state-specific Medicaid variations.
• Perform regulatory impact assessments and identify cross-platform dependencies.
• Provide technical leadership to Mainframe, Java, Facets, ETL, and QA teams.
• Conduct architecture reviews, technical quality assessments, and production-readiness reviews.
• Identify design gaps, integration risks, data impacts, and downstream regulatory impacts.
• Partner with Medicaid regulatory SMEs, business analysts, product owners, engineering, and QA teams.
Required Experience
• Deep TriZetto Facets architecture and implementation experience.
• Strong Mainframe architecture and application knowledge, including COBOL/JCL/DB2/CICS or comparable technologies.
• Strong Java/J2EE architecture and engineering knowledge.
• Experience with IBM DataStage.
• Experience with Talend/TalendWorks.
• Experience with enterprise APIs, integrations, batch systems, databases, and data architecture.
• Strong knowledge of Medicaid managed care and state-specific regulations.
• Good understanding of Medicare and Medicaid plan operations.
• Deep understanding of membership/eligibility and end-to-end claims processing.
• Experience architecting regulatory-driven changes across multiple integrated applications.
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