Looking for Healthcare Payer Enterprise Architect || Newark, NJ || Fulltime

Hi,

Hope you are doing well.

We do have a position for Healthcare Payer Enterprise Architect with our client. Please find the details below and if interested please send me your updated word format resume.

Tittle: Healthcare Payer Enterprise Architect

Location: Newark, NJ

Duration: Fulltime

Experience : 10-25 Years

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/Google Cloud Platform), 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 Enrolment & eligibility

o Provider network & contracting

o Care management & utilization

2. Payer Domain Transformation

• Architect end-to-end solutions integrating core admin platforms (Facets, QNXT, Health Edge) 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 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.

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.

Bhakti Chaudhari