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Design end-to-end AI and generative AI solutions for health plan use cases, including architecture, data flows, integration patterns, model selection, governance, security, and deployment approach
Partner with health plan stakeholders to identify high-value AI opportunities, define business outcomes, assess feasibility, and shape implementation roadmaps
Lead solutioning for payer-specific domains such as claims, enrollment, benefits, prior authorization, medical management, provider data, quality measures, risk adjustment, member services, and regulatory reporting
Develop reference architectures using cloud platforms, data lakes, warehouses, MLOps pipelines, APIs, workflow tools, and enterprise integration patterns
Guide teams on applying large language models, retrieval-augmented generation, predictive analytics, natural language processing, intelligent automation, and decision support in healthcare settings
Collaborate with data scientists, engineers, clinicians, compliance teams, security architects, and delivery leaders to move concepts from prototype to production
Define responsible AI controls, including model monitoring, explainability, human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance
Support pre-sales and client advisory activities, including solution presentations, proposals, estimates, demos, workshops, and executive briefings
Evaluate vendor platforms and AI tools across cloud, payer technology, data management, workflow automation, and clinical operations ecosystems
Create reusable assets, including solution blueprints, architecture patterns, implementation playbooks, data requirements, and governance frameworks
Strengthen alliances with key partners (Epic, Oracle Health, Microsoft, AWS, ServiceNow, cybersecurity vendors, Google, Leading AI players)
Build and mentor a high-performing team of AI leaders
Develop sales collateral for all solutions and services catering to healthcare payers
Requirements
Bachelor's degree in computer science, information systems, engineering, data science, healthcare informatics, or a related field
8+ years of experience in technology architecture, data architecture, analytics, AI/ML, or enterprise solution delivery
4+ years of experience supporting health plans, payers, managed care organizations, or healthcare administrative platforms
Hands-on experience designing AI, machine learning, generative AI, analytics, or automation solutions in production environments
Strong understanding of health plan business processes, including claims, membership, provider, utilization management, care management, quality, risk adjustment, and customer service
Experience with healthcare data standards and regulations, such as HIPAA, FHIR, HL7, X12 EDI, CMS interoperability requirements, and payer data exchange
Experience with major cloud platforms such as AWS, Azure, or Google Cloud, including data, AI, security, and integration services
Familiarity with modern AI patterns such as RAG, vector databases, prompt engineering, model evaluation, MLOps, LLMOps, and AI governance
Ability to communicate complex technical concepts to executive, clinical, operational, and technical audiences
Strong consulting, facilitation, problem-solving, and stakeholder management skills
8+ years of experience in designing and developing AI/ML solutions
4+ years of experience in healthcare Payer technology, consulting, or systems integration
What we offer
Medical, dental, and vision insurance
Flexible spending or health savings account
Life and AD&D insurance
Short and long term disability coverage
Paid time off
Employee assistance
Participation in a 401k program with company match