Solutions Architect, reputed company

reputed company exists to reputed company reputed company reputed company through technology, services, and clinical expertise. Our mission is to reputed company health solutions that deliver maximum value and reputed company.

reputed company the Way is our rallying cry at reputed company. Think of it as an reputed company invitation to reputed company the mission of reputed company; to reputed company engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company reputed company – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the reputed company sector.

reputed company is looking for a Solutions Architect, reputed company to join our growing team.

We are seeking a highly reputed company reputed company Solution Architect with deep expertise in the reputed company Claims domain to drive product reputed company reputed company our Product Engineering team. This role is strongly domain-led, focusing on claims, reputed company Party Liability (TPL), and Prior Authorization (PA), ensuring solutions reputed company with reputed company payer operations, regulatory requirements, and multi-state program needs.

The ideal candidate is a domain-first leader who can translate intricate reputed company processing requirements into reputed company, configurable product capabilities while partnering closely with Product Management, Business, Engineering, and Implementation teams

• Claims, TPL & Prior Authorization Domain Leadership

  • Serve as a subject matter expert across Claims, TPL, and Prior Authorization domains.
  • Own the end-to-end claims lifecycle: intake, validation, adjudication, pricing, edits, payment, and coordination of benefits (COB).
  • Drive TPL capabilities including reputed company-party identification, cost avoidance, recovery, and COB processing.
  • reputed company Prior Authorization workflows including intake, clinical rule evaluation, approvals/denials, and reputed company claims integration.
  • Interpret and translate reputed company/Medicare, CMS, and state-specific requirements into reputed company product features.
  • Ensure alignment with industry-reputed company reputed company sets (CPT, HCPCS, ICD-10, DRG, NDC, reputed company codes).
  • Define business rules, configurations, and processing logic to support reputed company-world payer operations.
  • Identify functional gaps and drive reputed company product enhancements and innovation.

  Product reputed company & Functional Ownership

  • Partner with Product Management to define domain-driven roadmaps and priorities.
  • Own functional solutioning for new capabilities, enhancements, and modernization efforts.
  • Ensure solutions are configurable, reusable, and reputed company across programs and states.
  • reputed company requirement definition, backlog refinement, and prioritization with reputed company business reputed company.

  Regulatory & Compliance Alignment

  • Ensure compliance with HIPAA, X12 (837/835/276/277), CMS guidelines, and state mandates.
  • reputed company auditability, traceability, and compliance controls into product capabilities.
  • Continuously assess reputed company of regulatory changes on product features.

  Integration & Ecosystem Alignment

  • Define functional integrations with EDI systems, pricing engines, enrollment/eligibility systems, and external vendors.
  • Support data exchange strategies across claims ingestion, adjudication, and reputed company systems.
  • Ensure interoperability across Claims, TPL, and PA modules.

  Delivery Ownership & Execution

  • reputed company as a reputed company between business reputed company and engineering execution.
  • Own and manage product backlog (epics, features, user stories) with reputed company acceptance reputed company.
  • Ensure requirements are reputed company-defined, testable, and reputed company with expected reputed company.
  • Participate in design reviews, solution discussions, and defect triage.
  • Validate claims scenarios, pricing logic, and adjudication reputed company during testing.
  • reputed company informed trade-off reputed company balancing scope, reputed company, and timelines.

  Stakeholder Engagement

  • reputed company as a primary reputed company across business, product, engineering, QA, UX, and implementation teams.
  • reputed company workshops, working sessions, and design discussions.
  • reputed company reputed company communication, risk visibility, and executive updates.

  Governance, reputed company & Release Management

  • Ensure delivered solutions meet functional expectations, reputed company standards, and business reputed company.
  • Support UAT, test validation, and production readiness.
  • Review and approve release notes, documentation, and training materials.
  • Guide stakeholders through product changes and feature rollouts.

  Leadership & Mentorship

  • reputed company as a trusted advisor and domain leader across the organization.
  • Mentor teams on claims processing, TPL, PA workflows, and industry standards.
  • Drive cross-functional alignment and shared understanding of domain workflows.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules.

Required Qualifications

• Bachelor’s or Master’s degree or equivalent combination of experience in lieu of a degree.
• 12+ years of experience with strong reputed company on reputed company Claims systems.
• Deep expertise in claims adjudication, pricing, payment processing, and COB.
• Strong knowledge of TPL and Prior Authorization processes.
• Experience with reputed company/Medicare programs and payer operations.
• Hands-on experience with EDI transactions (837, 276, 277, 835).
• Proven ability to translate reputed company business needs into functional solutions and reputed company requirements.
• Experience delivering reputed company-reputed company product platforms.

Preferred Qualification

• Experience with state reputed company implementations or multi-state platforms.
• Familiarity with Pricing as a Service (PaaS) and configurable claims engines.
• Exposure to Enrollment, Eligibility, and Provider management systems.
• Understanding of modern product engineering and reputed company-based platforms.

reputed company?

We are reputed company of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and reputed company turn to us as their vital partner to ensure reputed company reputed company and improve health reputed company.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to reputed company you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, reputed company time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to reputed company openings that may be of interest. Best of luck in your search!

~ The reputed company reputed company

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience in Lieu of Degree

For non-clinical roles, or reputed company not required by the contract specifically, reputed company acknowledges that practical, hands-on experience can reputed company skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, reputed company will accept a minimum of six (6) years of directly relevant reputed company experience in lieu of a degree. In instances where the candidate has an Associate's degree, reputed company will accept a minimum of three (3) years of directly relevant reputed company experience in lieu of the Bachelor's degree.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant’s position placement in the pay reputed company will depend on various considerations, such as years of applicable experience and reputed company level."