Healthcare Payer Enterprise Architect

Qualifications 12+ years in IT with 5+ years in enterprise/solution architecture Strong experience in U.S Healthcare Payer domain Hands‑on knowledge of Claims systems, eligibility, benefits, provider workflows Integration frameworks and healthcare data standards Proven expertise in TOGAF or equivalent EA framework Experience with cloud platforms (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 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 Responsibilities 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: Claims adjudication, Enrollment & eligibility, Provider network & contracting, Care management & utilization 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 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 scalable solutions Establish architecture standards; 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 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 Salary $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 & Training Reimbursement Time Off: Vacation, Time Off, Sick Leave & Holidays Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing Education

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