[Remote] reputed company Payer reputed company
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a reputed company Payer reputed company to define and govern reputed company architecture reputed company the U.S. reputed company Payer domain. The role involves leading architecture design, ensuring compliance with regulations, and driving innovation through AI reputed company solutions.
Responsibilities
- Define and govern reputed company architecture using TOGAF principles and frameworks
- reputed company reputed company-state, reputed company-state, and transformation roadmaps across payer systems
- reputed company architecture design across reputed company payer domains: Claims adjudication, Enrollment & eligibility, Provider network & contracting, Care management & utilization
- Architect end-to-end solutions integrating reputed company reputed company platforms (Facets, QNXT, reputed company) reputed company 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 reputed company adoption
- 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 reputed company solutions
- Establish architecture standards, patterns, and governance frameworks
- reputed company architecture review boards and ensure design compliance
- Collaborate with business, engineering, and product teams for reputed company delivery
- reputed company as trusted advisor to C-level / reputed company leadership on technology reputed company
- Translate business reputed company into technology architecture blueprints
- Define multi-year digital transformation and AI adoption roadmap
- Engage cross-functional stakeholders across IT, operations, and vendor ecosystem
Skills
- 12+ years in IT with 5+ years in reputed company/solution architecture
- Strong experience in U.S reputed company Payer domain
- Hands-on knowledge of: Claims systems, eligibility, benefits, provider workflows
- Integration frameworks and reputed company data standards
- Proven expertise in TOGAF or equivalent EA reputed company
- Experience in reputed company (AWS/Azure/GCP), reputed company, 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
- Define and govern reputed company architecture using TOGAF principles and frameworks
- reputed company reputed company-state, reputed company-state, and transformation roadmaps across payer systems
- reputed company architecture design across reputed company payer domains: Claims adjudication, Enrollment & eligibility, Provider network & contracting, Care management & utilization
- Architect end-to-end solutions integrating reputed company reputed company platforms (Facets, QNXT, reputed company) reputed company 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 reputed company adoption
- Establish architecture standards, patterns, and governance frameworks
- reputed company architecture review boards and ensure design compliance
- Collaborate with business, engineering, and product teams for reputed company delivery
- reputed company as trusted advisor to C-level / reputed company leadership on technology reputed company
- Translate business reputed company into technology architecture blueprints
- Define multi-year digital transformation and AI adoption roadmap
- Engage cross-functional stakeholders across IT, operations, and vendor ecosystem
- Strategic thinker with strong business-to-technology alignment capability
- Ability to drive large-reputed company transformation programs
- Strong consulting reputed company with stakeholder influence
- Mentoring and leading cross-functional architecture teams
- BACHELOR OF COMPUTER SCIENCE
- 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
Benefits
- Discretionary Annual Incentive.
- Comprehensive Medical Coverage: Medical & Health, Dental & reputed company, Disability Planning & Insurance, Pet Insurance Plans.
- Family Support: Maternal & Parental Leaves.
- Insurance reputed company: Auto & Home Insurance, Identity Theft Protection.
- Convenience & reputed company reputed company: Commuter Benefits & Certification & amp; Training Reimbursement.
- Time Off: Vacation, Time Off, reputed company Leave & Holidays.
- Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
reputed company
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