Solutions Architect - Healthcare Payer

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

Job Title: Solutions Architect - Healthcare Payer

Location: Princeton NJ / Chicago IL

About Coforge

Coforge is a global digital services and solutions provider, that leverages emerging technologies and deep domain expertise to deliver real-world business impact for its clients. A focus on select industries, a deep domain understanding of the underlying processes of those industries and partnerships with leading technology platforms, enables Coforge to be a trusted partner of its clients in their transformation initiatives. Coforge leads with its Product Engineering approach and leverages AI, Cloud, Data, Integration and Automation technologies to transform businesses into intelligent, high growth enterprises. Coforge has twin headquarters in Princeton, USA & Greater Noida, India and employs over 33,000 technology and business process professionals with presence across 25 countries and 33 global delivery centers.

Coforge's proprietary platforms power critical business processes across its core verticals of BFS, Insurance, Travel, Transportation, and Hospitality (TTH), Retail & CPG, Healthcare. Our technology & process consultants engineer, design, consult, operate and modernize systems across the world. We take immense pride in the culture we have built and our low employee attrition; we are proud to be recognized as a Great Place to Work 2025 for the 5th year in a row and among the Top 50 in India’s Best Workplaces in IT & IT-BPM 2025. Coforge was also declared the winner of the ‘Golden Peacock Award for Excellence in Corporate Governance for the year 2025. At Coforge, we measure success by the comprehensive value we create for clients, employees, shareholders, partners, and communities alike.

Role Overview

We are looking for a seasoned Healthcare Payer Solutions Architect with strong domain expertise in the U.S. health insurance industry. The ideal candidate will have hands‑on experience working with major payers such as Blue Cross Blue Shield, UnitedHealthcare, Aetna, or similar. This role requires a strong understanding of payer operations, including Claims, EDI, Enrollments, Premium Billing, Case management/Prior Authorization, Provider Network, Customer Service, and Payer Data Management.

You will support during the sales cycle, collaborating with sales, product, and delivery teams to craft compelling solutions that address client pain points and align with their business goals.

Key Responsibilities:

• Partner with sales to develop and deliver solution presentations, work on proposals and give demos as
• Attend discovery sessions with prospective clients to understand their business needs and technical requirements.
• Translate payer workflows into solution blueprints and value propositions.
• Support RFP/RFI responses, proof-of-concept (POC) development, and solution workshops.

Domain Expertise & Thought Leadership

• Serve as a advisor to clients on payer operations, regulatory compliance, and digital transformation.
• Stay current on industry trends, CMS mandates, interoperability standards (e.g., HL7, X12, FHIR), and payer technology ecosystems.

Solution Design & Customization

• Collaborate with engineering and operations teams to align offerings with market needs.
• Design end‑to‑end solutions across key payer functions: Claims adjudication, EDI transactions, Enrollment & Eligibility, Premium Billing, Customer Service, Case Management/Prior Authorization and Data Analytics.
• Should be able to build functional & technical architecture to drive the solutions in the above payer areas.
• Coordinate with various horizontal technology practices to estimate the solution.

Required Qualifications:

• 15+ years of experience in the U.S. healthcare payer industry, including direct experience with payers like (e.g., BCBS, Aetna, Cigna).
• Strong 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).

Preferred Qualifications:

• Experience working with the payer platforms e.g. FACETS, HealthEdge, Custom payer systems
• Familiarity with other technology solutions implemented in Healthcare (Salesforce Health cloud, Vlocity, EDIFECS, CCaaS solution like NICE/Genesys etc.).