Senior Healthcare Payer Solutions Architect (US)

Coforge; Illinois; On-site; USD 140,000 - 190,000; Full time

Job summary

Coforge is seeking a seasoned Healthcare Payer Solutions Architect to drive end-to-end solutions for U.S. health insurers. You will work across sales, product, and delivery to craft compelling payer-focused architectures.

The role demands deep payer operations knowledge and experience with interoperability standards, guiding clients through digital transformation and regulatory compliance.

Qualifications

• 15+ years of experience in the U.S. healthcare payer industry with direct payer exposure.
• Deep knowledge of payer operations: Claims processing, EDI (X12 837/835/270/271), Enrollment, Premium Billing, Case management/Prior Authorization, and Customer Service.
• Strong understanding of healthcare data standards and regulatory frameworks (HIPAA, ACA, CMS interoperability rules).

Responsibilities

• Partner with sales to develop and deliver solution presentations, proposals, and demos.
• Attend discovery sessions with prospective clients to understand business needs and technical requirements.
• Translate payer workflows into solution blueprints and value propositions.
• Support RFP/RFI responses, POC development, and solution workshops.
• Serve as advisor to clients on payer operations, regulatory compliance, and digital transformation.
• Stay current on industry trends, CMS mandates, interoperability standards (HL7, X12, FHIR), and payer technology ecosystems.
• Collaborate with engineering and operations to align offerings with market needs.
• Design end-to-end solutions across Claims adjudication, EDI, Enrollment & Eligibility, Premium Billing, Customer Service, and Data Analytics.

Skills

HL7

X12

FHIR

Job description

Coforge is seeking a seasoned Healthcare Payer Solutions Architect to drive end-to-end solutions for U.S. health insurers. You will work across sales, product, and delivery to craft compelling payer-focused architectures.

The role demands deep payer operations knowledge and experience with interoperability standards, guiding clients through digital transformation and regulatory compliance.