Operations Solution Architect

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $160k - $200k / year

⏰ Full Time

🟠 Senior

🔴 Lead

💻 Solutions Engineer

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

Healthcare Insurance • SaaS • Fintech

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Lead service model design and solution blueprinting for health plan Core Administration transformation initiatives. • Assess current-state operations on legacy platforms and define transition pathways to BPaaS delivery models. • Design future-state operating models spanning claims, enrollment, billing, and member operations with a focus on efficiency and outcomes. • Define how BPaaS service layers connect across the health plan ecosystem including care management, provider data management, and analytics. • Support Advisory and Sales teams on strategic BPaaS pursuits, proposals, and operational discussions with health plan leaders. • Conduct current-state assessments and create modernization roadmaps grounded in operational realities and priorities. • Mentor team members and partner with technology teams to ensure feasibility and alignment with service model commitments.

🎯 Requirements

• 10–15+ years in health plan operations, Core Administration, or healthcare BPaaS strategy. • Deep operational expertise across one or more Core Admin domains: claims, enrollment, billing, benefits administration, UM, A&G, provider, and member services. • Proven ability to assess operational models and design future-state BPaaS service blueprints. • Strong familiarity with Core Admin platforms (HealthRules Payer, Facets, QNXT, QicLink, Javelina, or equivalent). • Strong sales-facing skills: whiteboarding, pursuit support, and executive communication with health plan leadership. • Exceptional analytical, communication, and client-facing presence.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options