Sr. Business Architect

Are you interested in working with the World’s leading AI-powered Quality Engineering Company? Ready to advance your career, team up with global thought leaders across industries and make a difference every day? Join us at Qualitest!

We are looking for a Business Architect to join our growing team in United States! 
Required Skills & Experience:

• 10+ years of experience as a Business Analyst or similar role, ideally in digital transformation and healthcare payer domains.
• Strong expertise of healthcare payer concepts including claims lifecycle, fee schedules, contracts, and pricing adjudication.
• Hands-on experience working with pricer tools and claims pricing logic.
• Knowledge of 837 claim transaction sets and EDI standards.
• Deep knowledge of healthcare payer systems, preferably with experience in Trizetto Facets or comparable platforms.
• Strong technical background with proficiency in SQL, data modeling (star/snowflake schema, SCDs), and software development lifecycle concepts.
• Experience with integration technologies such as REST APIs, SOAP, and SOA architecture.
• Familiarity with software frameworks and tools such as C#, .NET, PL/SQL, and database platforms like Oracle and MS SQL Server.
• Demonstrated ability to lead ambiguity reviews, transition management, and change initiatives in complex program environments.
• Excellent communication, stakeholder management, and documentation skills.
• Experience managing or collaborating with offshore teams is a plus.
•  

Key Responsibilities:

• Lead large-scale digital transformation programs, including legacy system replatforming, data normalization, and modernization efforts.
• Elicit, analyze, and translate business requirements into clear technical specifications and process flows, leveraging expertise in healthcare payer domain (claims, membership, billing, provider modules).
• Work with pricer tools and expertise in pricing of claims, fee schedules, contracts, and payer concepts to ensure accurate claims adjudication and financial modeling.
• Leverage knowledge of 837 claim transaction sets and Electronic Data Interchange (EDI) standards to support claims processing and integration.
• Collaborate closely with cross-functional teams including architects, developers, QA, and offshore teams to ensure high-quality, timely delivery.
• Drive requirements transformation, ambiguity resolution, and change management to support agile and waterfall SDLC methodologies.
• Define and document reference architectures, data flows, and process models to facilitate shared expertise and compliance.
• Support solution design and integration initiatives using APIs, SOA, RESTful/SOAP web services, and enterprise system extensions.
• Utilize strong data modeling, SQL, and ETL skills to support data extraction, transformation, and reporting activities across heterogeneous data sources.
• Partner with technical leads and project managers to monitor program health, risks, and deliverables ensuring alignment with business objectives.
• Champion best practices in business assurance, quality management, and automation strategies.

Preferred Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, Healthcare IT, or related field.
• Certification in Business Analysis (CBAP, PMI-PBA) or Agile methodologies.
• Prior experience in large-scale legacy system replatforming or data modernization programs.

Are you interested in working with the World’s leading AI-powered Quality Engineering Company? Ready to advance your career, team up with global thought leaders across industries and make a difference every day? Join us at Qualitest!

We are looking for a Business Architect to join our growing team in United States! 
Required Skills & Experience:

• 10+ years of experience as a Business Analyst or similar role, ideally in digital transformation and healthcare payer domains.
• Strong expertise of healthcare payer concepts including claims lifecycle, fee schedules, contracts, and pricing adjudication.
• Hands-on experience working with pricer tools and claims pricing logic.
• Knowledge of 837 claim transaction sets and EDI standards.
• Deep knowledge of healthcare payer systems, preferably with experience in Trizetto Facets or comparable platforms.
• Strong technical background with proficiency in SQL, data modeling (star/snowflake schema, SCDs), and software development lifecycle concepts.
• Experience with integration technologies such as REST APIs, SOAP, and SOA architecture.
• Familiarity with software frameworks and tools such as C#, .NET, PL/SQL, and database platforms like Oracle and MS SQL Server.
• Demonstrated ability to lead ambiguity reviews, transition management, and change initiatives in complex program environments.
• Excellent communication, stakeholder management, and documentation skills.
• Experience managing or collaborating with offshore teams is a plus.
•  

Key Responsibilities:

• Lead large-scale digital transformation programs, including legacy system replatforming, data normalization, and modernization efforts.
• Elicit, analyze, and translate business requirements into clear technical specifications and process flows, leveraging expertise in healthcare payer domain (claims, membership, billing, provider modules).
• Work with pricer tools and expertise in pricing of claims, fee schedules, contracts, and payer concepts to ensure accurate claims adjudication and financial modeling.
• Leverage knowledge of 837 claim transaction sets and Electronic Data Interchange (EDI) standards to support claims processing and integration.
• Collaborate closely with cross-functional teams including architects, developers, QA, and offshore teams to ensure high-quality, timely delivery.
• Drive requirements transformation, ambiguity resolution, and change management to support agile and waterfall SDLC methodologies.
• Define and document reference architectures, data flows, and process models to facilitate shared expertise and compliance.
• Support solution design and integration initiatives using APIs, SOA, RESTful/SOAP web services, and enterprise system extensions.
• Utilize strong data modeling, SQL, and ETL skills to support data extraction, transformation, and reporting activities across heterogeneous data sources.
• Partner with technical leads and project managers to monitor program health, risks, and deliverables ensuring alignment with business objectives.
• Champion best practices in business assurance, quality management, and automation strategies.

Preferred Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, Healthcare IT, or related field.
• Certification in Business Analysis (CBAP, PMI-PBA) or Agile methodologies.
• Prior experience in large-scale legacy system replatforming or data modernization programs.