Job Responsibilities:

• Lead solution architecture, design, and implementation for Zelis Payment Integrity and TPA platform projects.
• Collaborate with business and IT stakeholders to define technical strategies that align with organizational goals.
• Design integration solutions to enable efficient data exchange between payer platforms, claims processing systems, and external vendors.
• Provide technical leadership for system migrations, enhancements, and data transformations.
• Develop high-level and detailed solution designs, including system architecture diagrams, workflows, and API integrations.
• Ensure compliance with HIPAA, HITRUST, and other healthcare data security standards.
• Engage with vendors and third-party solution providers to evaluate and implement scalable solutions.
• Troubleshoot complex system issues and drive resolution across multi-functional teams.

Qualifications & Skills:

• 5+ years of experience as a Solution Architect or Engineer in a healthcare payer environment.
• Strong understanding of claims adjudication, provider payments, and healthcare data management.
• Experience with the Zelis Payment Integrity solution and TPA implementation is highly preferred.
• Experience with payer platforms such as Trizetto Facets.
• Proficiency in cloud platforms and data pipelines.
• Strong background in SQL, ETL processes, and data warehouse solutions.
• Familiarity with networking, security, IAM, data governance, and compliance frameworks related to healthcare IT.
• Excellent problem-solving, communication, and leadership skills.
• Experience with Agile and DevOps methodologies.