BC sector health-Senior-Health Business Architect

Job Description: Health Business Architect Payer Domain

Role Overview

We are seeking a seasoned Business Architect with deep experience in the health insurance (payer) domain and hands-on expertise with Health technologies. The candidate will serve as a strategic consulting partner to business and IT own the end-to-end business architecture and lead the design and delivery of health business-enabled capabilities across claims benefits provider and member operations.

Key Responsibilities

• Leads end to end business architecture development across core healthcare payer functions such as claims enrolment provider network care management UM/CM and billing.
• Aligns business strategy technology solutions and operating models to enable enterprise transformation.
• Develops capability models value streams future state process designs and target operating models to guide modernization initiatives.
• Conducts current state assessments identifies operational and system gaps and recommends improvements to drive efficiency compliance and member/provider experience.
• Partners closely with product IT clinical and operations teams to design and support digital transformation and platform implementations.
• Acts as a bridge between business stakeholders and technical teams translating requirements into functional designs and ensuring solution alignment.
• Builds strategic roadmaps business cases and value realization plans to articulate benefits and investment priorities.
• Ensures alignment with regulatory requirements such as CMS HIPAA NCQA HEDIS and payer compliance standards.
• Supports change management communication and adoption planning to ensure smooth rollout of new processes and systems.
• Facilitates executive-level presentations strategic discussions and decision support for transformation initiatives.

Required Qualifications

• 812 years of experience in the healthcare payer domain with a strong consulting background leading large scale business and technology transformation initiatives.
• Deep understanding of payer core administration platforms (e.g. HealthEdge Facets QNXT Health Rules Javelina or similar technologies) with experience in solution design business architecture configuration oversight or product leadership.
• Strong functional expertise across key payer operations including claims processing benefit/product modeling provider data management pricing & payment integrity accumulators enrollment & membership and customer service workflows.
• Demonstrated ability to lead executive and SME workshops facilitate requirement discovery and produce high quality deliverables such as process maps capability models business architecture blueprints and transformation roadmaps.
• Comprehensive understanding of regulatory and compliance requirements including HIPAA CMS mandates Medicare/Medicaid policies and state specific payer regulations.
• Excellent communication stakeholder management and documentation skills with the ability to translate complex business needs into technology aligned solutions and effectively bridge business and IT teams.
• Proven experience working in agile environments including participation in PI planning backlog refinement user story creation acceptance criteria definition and leadership of UAT cycles.

Preferred Qualifications

• Experience working across multiple health plan typesincluding national and regional commercial plans Medicare Advantage Medicaid and employer group planswith a proven track record of supporting successful system deployments and go lives.
• Exposure to leading healthcare payer and care management platforms such as HealthEdge Source (payment integrity) GuidingCare (care management) Wellframe (member engagement) and industry standard provider data management solutions.
• Knowledge of integrations involving CRM platforms (e.g. Salesforce) enterprise data ecosystems (EDW Lakehouse) clearinghouses PBMs utilization management systems and other ecosystem interfaces commonly used in payer environments.
• Professional certifications such as AHIP or product specific training/certifications on market leading payer platforms (e.g. HealthEdge Facets QNXT or similar) demonstrating strong domain and solution expertise.
• savings provider data accuracy and member NPS; drive continuous improvement.

Education

• Bachelors or Masters degree in Business Healthcare Administration Information Systems or related field.

Location & Work Model

• Preferred location: Open to onshore/offshore hybrid model; ability to travel for key workshops and go-live support as needed.

Equal Opportunity Employer

• We are an equal opportunity employer and value diversity. All employment is decided based on qualifications merit and business need.