Solutions and Services Architect (Fully Remote)

Personify Health, Inc.; United States; Remote; USD 120,000 - 160,000; Full time

Benefits offered by this job

Medical and dental coverage

Unlimited PTO

Mental health support

Professional development

Retirement planning

Job summary

Personify Health is seeking an experienced healthcare architect to design operational workflows for eligibility, claims, billing, and benefit administration. You will act as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.

You will negotiate rebates and pricing agreements while tracking drug costs and PMPM performance, and collaborate across teams to optimize health plan administration and care navigation.

Qualifications

• 7+ years in healthcare, TPA operations, product, or systems architecture.
• Deep knowledge of PBM operations, data formats, and compliance requirements (HIPAA, CMS).
• Strong skills in process documentation, analytics, and cross-functional collaboration.

Responsibilities

• Design operational workflows for eligibility, claims, billing, and benefit administration.
• Serve as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.
• Negotiate rebate and pricing agreements while tracking drug cost and PMPM performance.

Skills

PBM operations

HIPAA CMS compliance

Process documentation

Analytics

Cross-functional collaboration

Education

7+ years healthcare/TPA operations experience

Job description

• Design operational workflows for eligibility, claims, billing, and benefit administration.
• Serve as the go-to architect for PBM solutions, data exchanges, and vendor onboarding.
• Negotiate rebate and pricing agreements while tracking drug cost and PMPM performance.

What You Bring:

• 7+ years in healthcare, TPA operations, product, or systems architecture.
• Deep knowledge of PBM operations, data formats, and compliance requirements (HIPAA, CMS).
• Strong skills in process documentation, analytics, and cross-functional collaboration.

Value diversity and inclusion with a mission-driven culture.

Commitment to empowering employees from all backgrounds to thrive.

• Comprehensive medical and dental coverage effective day one.
• Unlimited PTO and mental health support.
• Professional development and retirement planning.

Personify Health

Personify Health created the first and only personalized health platform bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. They serve employers, health plans, and health systems with data-driven solutions that reduce costs and improve health outcomes.