Solutions Architect

About the Role

We are looking for a seasoned Solution Architect with deep expertise in Health Plan IT services to join our growing Healthcare practice. In this role, you will be responsible for designing and delivering end-to-end technology solutions for large Payer organizations, including Blue Plans, Payviders, and regional health plans. You will work at the intersection of business and technology, translating complex payer business problems into scalable, innovative, and cost-effective solutions.

This is a high-impact, client-facing role that requires a blend of domain depth, architectural thinking, and a passion for leveraging emerging technologies to transform healthcare operations.

Key Responsibilities

Solution Design & Architecture

You will lead the design of comprehensive IT solutions for Health Plan clients, covering core administrative platforms, digital transformation initiatives, and next-generation technology integrations. You will develop solution blueprints, reference architectures, and detailed technical proposals aligned to client business objectives such as cost reduction, operational efficiency, member experience improvement, and faster time to market.

Client Engagement & Solutioning

You will engage directly with Payer clients including Blue Cross Blue Shield Plans, Payviders, and regional and national health plans to understand their strategic priorities, pain points, and technology landscape. You will lead pre-sales solutioning efforts, respond to RFPs and RFIs, and present architectural recommendations to client stakeholders at both business and IT leadership levels.

Domain Coverage

You will apply your expertise across core Health Plan business functions including:

Enrollment & Billing

Claims Processing & Adjudication

Appeals & Grievances

Member Services

Provider Data Management

Care Management

You will demonstrate a clear understanding of Lines of Business such as Commercial, Medicare (FFS and Medicare Advantage), Medicaid, Marketplace (ACA), and Dual Eligible programs, and how operational and regulatory requirements differ across these lines.

Technology & Platform Expertise

You will design solutions leveraging core administrative platforms such as Facets, QNXT, and HealthEdge Health Rules Payor (HRP), and other leading payer administration systems. You will incorporate modern capabilities including Artificial Intelligence, Generative AI, Process Mining, Digital Twin, and Intelligent Automation into solution architectures to drive measurable business value. You will guide clients on platform modernization, cloud migration, and integration strategies across their payer ecosystem.

Delivery Oversight & Governance

You will provide architectural governance throughout delivery, ensuring solutions are built to design, are scalable, and meet compliance, interoperability, and security standards including HIPAA, HL7 FHIR, and EDI 834/835/837 transaction sets. You will collaborate with delivery leads, engineering teams, and SMEs to resolve architectural challenges and maintain solution integrity.

Thought Leadership

You will contribute to the development of accelerators, points-of-view, and reusable solution assets for the Healthcare Payer practice. You will stay current with industry trends, CMS regulatory changes, and emerging technologies, and translate these into actionable insights for clients and internal teams.

Required Qualifications

• 5 to 10 years of overall IT experience, with at least 3 to 5 years in a Solution Architect or Senior Consultant role focused on Healthcare Payer organizations.
• Proven solutioning experience with large Payer clients including Blue Plans, national carriers, Payviders, or regional health plans.
• Strong functional knowledge of Health Plan business processes Enrollment & Billing, Claims, Appeals & Grievances, Member Services, Provider Services, and Utilization Management.
• Solid understanding of Payer Lines of Business including Commercial, Medicare Advantage, FFS Medicare, Medicaid, Marketplace/ACA, and Dual Eligible populations.
• Hands-on experience with one or more core Payer administration platforms such as Facets, QNXT, HealthEdge HRP, or equivalent.
• Working knowledge of healthcare data standards and interoperability frameworks including HL7 FHIR, EDI X12 transactions (834, 835, 837), and CMS regulatory requirements.
• Exposure to and ability to solution with emerging technologies including AI/ML, Generative AI, Process Mining, Digital Twin, and RPA/Intelligent Automation.
• Strong communication and presentation skills with experience engaging C-suite and senior IT leadership stakeholders.
• Demonstrated experience in pre-sales, RFP responses, and effort estimation for large-scale Health Plan transformation programs.

Preferred Qualifications

AHM-250 certification (America's Health Insurance Plans) or equivalent Health Plan industry certification is highly desirable.

• Familiarity with cloud platforms (AWS, Azure, or GCP) and their application in Payer IT modernization.
• Experience with Process Mining tools such as Celonis, UiPath Process Mining, or similar platforms applied to claims or operational workflows.
• Exposure to Value-Based Care models, Risk Adjustment, or Stars/HEDIS quality programs.
• Prior experience working in a Big 4 consulting firm, IT services organization, or a Payer IT product company is an advantage.

What We Offer

• Opportunity to work with marquee Payer clients across the US Health Insurance landscape.
• A collaborative and innovation-driven culture with access to cutting-edge GenAI and automation capabilities.
• Strong investment in learning, certifications, and career growth within the Healthcare practice.
• Competitive compensation, flexible work arrangements, and a people-first work environment.