[Remote] Healthcare Payer Enterprise Architect
Note: The job is a remote job and is open to candidates in USA. Tata Consultancy Services is seeking a Healthcare Payer Enterprise Architect to define and govern enterprise architecture within the U.S. Healthcare Payer domain. The role involves leading architecture design, ensuring compliance with regulations, and driving innovation through AI and digital solutions.
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
- 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
- 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
Skills
- 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 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
- 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
- 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
- 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
- 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
- BACHELOR OF COMPUTER SCIENCE
- 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
Benefits
- 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.
Company Overview
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