Payer Platform Tech Lead CapAdmin & Claims

Alivi Health; Miami (FL); Hybrid; USD 140,000 - 175,000; Full time

Job summary

Alivi Health is seeking a Lead Software Developer with deep healthcare payer domain expertise to join our CapAdmin platform team. This hybrid leadership role bridges engineering and payer knowledge, focusing on architecture, requirements validation, and SME guidance to ensure features are built right the first time.

The ideal candidate has 6+ years in payer/TPA environments, strong C#/.NET or Java, and hands-on experience with UB04, COB, UM, capitation, EDI, and data with SQL.

Qualifications

• 6+ years in payer/TPA domain software
• Hands-on with UB04 and CMS-1500 claim processing
• COB rules and logic, UM workflows
• Capitation models and reconciliation
• EDI transactions (837/835/834/270/271/278)
• CPT/HCPCS/ICD-10 knowledge; payer requirements familiarity

Responsibilities

• Bridge architecture, scalability, and platform modernization.
• Mentor mid-level developers on payer concepts.
• Ensure full payer-domain context before sprint commitment.
• Define and document acceptance criteria grounded in payer regulations.
• Collaborate with BAs, QA, and Product to eliminate root causes of defects.

Skills

C# / .NET

Java

REST APIs

Microservices

SQL Server / PostgreSQL

AWS (Redshift / QuickSight)

CI/CD / DevOps

Agile / Scrum

Mentoring

English / Spanish bilingual

Tools

Facets

QNXT

HealthRules

TriZetto

Job description

Alivi Health is seeking a Lead Software Developer with deep healthcare payer domain expertise to join our CapAdmin platform team. This hybrid leadership role bridges engineering and payer knowledge, focusing on architecture, requirements validation, and SME guidance to ensure features are built right the first time.

The ideal candidate has 6+ years in payer/TPA environments, strong C#/.NET or Java, and hands-on experience with UB04, COB, UM, capitation, EDI, and data with SQL.