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
2. 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
3. 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
4. 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
5. 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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