The Solution Architect is responsible for leading large-scale U.S. healthcare payer contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility. This role owns end-to-end delivery excellence including SLAs, regulatory compliance, financial performance, workforce productivity, and transformation initiatives across Commercial, Medicare, and Medicaid lines of business. The role serves as a senior client-facing leader managing complex multi-LOB healthcare operations while driving cost optimization, quality, and AI-led transformation.
Responsibilities and Duties:
• Provide hands on leadership for 200 - 400+ FTE U.S. healthcare contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility
• Act as a U.S. payer domain SME with deep understanding of member and provider journeys
• Own end to end KPIs and SLAs including AHT, ASA, FCR, quality, accuracy, grievance TAT, and appeals resolution
• Ensure compliance with U.S. healthcare regulations including HIPAA, CMS, Medicare, Medicaid, ACA, and state mandates
• Lead governance with U.S. payer leadership across Operations, CX, Compliance, and Medical Management
• Drive cost to serve reduction through workforce optimization, automation, and AI led interventions
• Lead U.S. healthcare transformation initiatives including digital self service, contact reduction, intelligent routing, and agent assist
• Proactively identify and mitigate operational, regulatory, and compliance risks
• Support U.S. healthcare pursuits and expansions with SME ownership for solutioning, pricing, and operating model design
• Own delivery financials including budgeting, productivity targets, and P&L performance
• Build leadership capability across Managers and Senior Managers and drive a high performance delivery culture
Qualifications:
• Bachelors or masters degree in business administration or related discipline
• 13+ years BPO and contact center delivery operations
• 10+ years in U.S. healthcare contact center leadership roles
• Mandatory experience in U.S. Member Services across Commercial, Medicare, or Medicaid
• Strong exposure to Provider Services and payer back-office integration
• Hands-on experience with payer platforms such as Facets, QNXT, WGS, PEGA, and portals
• Strong knowledge of CMS audits, HEDIS, STAR ratings, and G&A processes
• Lean Six Sigma Green or Black Belt Certification preferred
Salary Range: $138,600 - $187,500 a year
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