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/GCP), 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 Enrollment & eligibility
o Provider network & contracting
o Care management & utilization
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- Payer Domain Transformation
- Architect end-to-end solutions integrating core admin platforms (Facets, QNXT, HealthEdge) 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
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- 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
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- Architecture Governance & Leadership
- Establish architecture standa rds, 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
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- 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
Salary Range: $130,000- $150,000 a year
TCS Employee Benefits Summary:
Discretionary Annual Incentive.
Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
Family Support: Maternal & Parental Leaves.
Insurance Options: Auto & Home Insurance, Identity Theft Protection.
Convenience & Professional Growth: Commuter Benefits & Certification & amp; Training Reimbursement.
Time Off: Vacation, Time Off, Sick Leave & Holidays.
Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
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