$130,000–$150,000 Per Year
Adjudication, Amazon Web Services (AWS), Application Programming Interface (API), Architectural Design, Artificial Intelligence (AI), Automation, Blueprints, Business Strategy, C-Level Management, Cloud Computing, Communication Skills, Consulting, Content Management Systems (CMS), Cross-Functional, Ecosystems, Electronic Data Interchange (EDI), Enterprise Architecture, GCP (Good Clinical Practices), HIPAA (Health Insurance Portability and Accountability Act), HL7 (Health Level 7), Healthcare, Interoperability, Leadership, Legal, Loan Funding, Maintain Compliance, Mentoring, Microservices, Microsoft Windows Azure, National Committee for Quality Assurance (NCQA), Printed Circuit Board Design, Provider Contracting, Regulatory Compliance, Sales Qualification, Software Development Lifecycle (SDLC), Student Loans, Systems Administration/Management, TOGAF - The Open Group Architecture Framework, Team Lead/Manager, Technical Strategy, Use Cases, Utilization Management, Vehicle Driving
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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