The Enterprise Data Architect sets the technical foundation for how data is structured, integrated, stored and governed across our Medicare Advantage health plan - translating business strategy into scalable, compliant, and future-ready data solutions/services. This role partners directly with clinical operations, actuarial, compliance, IT, and business intelligence teams to ensure data assets support accurate risk adjustment, Star ratings performance, regulatory reporting, and member outcomes. The position drives measurable impact on the organization's ability to use data as a strategic asset - enabling analytics, AI/ML capabilities, and CMS-compliant reporting at scale.

Job Duties/Responsibilities

Design and govern the data architecture that spans operational systems, cloud platforms, and analytics environments to support clinical and business workflows across our Medicare Advantage lines of business.

Build and maintain data models (conceptual, logical, and physical) that enable accurate risk adjustment, HEDIS reporting, Star ratings optimization, and encounter data submissions to CMS.

Establish and enforce data governance frameworks - in coordination with the Data Governance, compliance, and privacy teams - covering data quality, lineage, PHI/PII classification, and audit readiness.

Integrate structured and unstructured data from claims systems, EHRs, pharmacy platforms, and third-party sources into unified, reliable data pipelines that serve analytics and operational decision-making.

Define and uphold security architecture that meets HIPAA, CMS, and SOC 2 requirements while enabling appropriate, governed access for analytics teams and business consumers.

Evaluate and recommend data platforms, cloud technologies, and vendors - including tools for data virtualization, orchestration, consumption, analytics and AI/ML infrastructure - that align with organizational strategy and roadmap priorities.

Serve as the primary technical data partner to cross-functional leaders across clinical operations, population health, finance, product, and compliance - translating complex architecture decisions into clear business context.

Advance data-enabled innovation by scoping and piloting emerging capabilities - including generative AI, FHIR-based interoperability, and real-time streaming - that support care management and member engagement initiatives.

Supervisory Responsibilities

This role does not carry direct supervisory responsibility. The Enterprise Data Architect leads through technical authority and cross-functional influence across engineering, analytics, governance, and business teams.

Job Requirements

Experience

Required:

• 10+ years of progressive experience in data architecture, enterprise data integration, and database design

• Minimum 2 years of experience working in a health plan, payer, or healthcare delivery system with direct familiarity with claims data, EHRs, HEDIS, and CMS reporting environments

• Demonstrated experience designing data platforms in regulated, audit-sensitive environments with PHI and PII datasets (including canonical models for Enterprise Data Platforms)

• Proven experience with cloud data platforms (AWS, Azure, or GCP) and modern architecture patterns including data lakes, lakehouses, and real-time streaming

• Experience leading cross-functional architecture initiatives and influencing senior stakeholders without direct authority

• Experience with working in agile delivery model.

Preferred:

• Experience designing data solutions for Medicare Advantage-specific programs including risk adjustment, Star ratings, RADV audits, and value-based care models

• Experience enabling AI/ML and generative AI capabilities within a healthcare data platform context

• Background in DataOps, Agile delivery methodologies, and healthcare interoperability standards (FHIR, HL7)

Education

Required:

• Bachelor's degree in Computer Science, Information Systems, Data Science, Engineering, or a related technical field; equivalent combination of education and demonstrated experience will be considered

Preferred:

• Master's degree in a related technical or data discipline

Training

Required:

• Demonstrated working proficiency with cloud data platforms (Azure Databricks, Snowflake, BigQuery, Redshift, or equivalent) acquired through direct hands-on project experience

Preferred:

• Cloud platform certification (AWS Certified Data Analytics, Azure Data Engineer Associate, or Google Professional Data Engineer)

• Data governance or architecture certification (TOGAF, DAMA-CDMP)

Skills & Competencies

Technical / Role-Specific Skills

• Data Architecture & Modeling - Expert-level proficiency in conceptual, logical, and physical data modeling using industry methodologies (Kimball, Inmon, Data Vault).

• Cloud Data Platforms - Hands-on experience with Snowflake, Databricks, BigQuery, or Redshift; familiarity with data lake and lakehouse architectures.

• Data Integration & Orchestration - Working knowledge of ETL/ELT tools and orchestration platforms (Informatica, Talend, dbt, Airflow).

• Healthcare Data Standards & Regulatory Knowledge - Applied knowledge of Medicare Advantage data constructs including HIPAA, CMS encounter data, HEDIS, STAR ratings, risk adjustment (HCC coding), and ICD-10/CPT codes.

• Data Governance & Security - Demonstrated ability to design and enforce governance frameworks, data classification, lineage tracking, and PHI/PII protection across regulated environments.

• SQL & Programming - Advanced SQL proficiency; working knowledge of Python or Scala for data engineering and pipeline use cases.

• AI/ML-Enabling Infrastructure - Familiarity with MLflow, Feature Store, vector databases, LangChain, and generative AI APIs in the context of healthcare data environments.

Licensure

Required:

• None required for this role.

Preferred:

• TOGAF (The Open Group Architecture Framework)

• DAMA Certified Data Management Professional (CDMP)

• AWS Certified Data Analytics, Azure Solutions Architect, or Google Professional Cloud Architect

• CPHIMS (Certified Professional in Health Informatics and Information Management) or equivalent healthcare IT credential

Essential Physical Functions

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $130,332.00 - $195,498.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.