Distinguished Architect, Software Development – Claims Automation, Processor Enablement

This is a fully remote position, open to applicants in Texas.

📋 Description

• Define and take ownership of the comprehensive technical vision for the Claims Automation and Processor Enablement ecosystem.

• Establish the interaction of intelligent claim assessment, decision-making, workflow orchestration, processor-facing automation, Payment Integrity capabilities, and core adjudication services throughout the claim lifecycle.

• Outline capability boundaries, integration patterns, APIs, events, and shared services across independently managed products and platforms.

• Create and sustain an architectural blueprint illustrating capability interactions, data exchange, and their evolution over time.

• Identify overlapping capabilities and drive convergence, reuse, consolidation, or intentional separation.

• Steer technology decisions based on business outcomes, engineering suitability, operational risk, vendor maturity, talent availability, and total cost of ownership.

• Define methodologies for managing claim complexity, Payment Integrity risk, business rules, analytics, and intelligent recommendations throughout the claim lifecycle.

• Establish procedures for the creation, governance, consumption, measurement, and enhancement of decision outputs.

• Ensure automation provides traceability, explainability, auditability, regulatory compliance, and human oversight.

• Guide the responsible integration of AI-assisted capabilities.

• Collaborate with engineering leaders on legacy and platform modernization, defining transitional architectures.

• Identify platform constraints and influence modernization priorities.

• Challenge technical assumptions and resolve competing strategies across different organizations.

• Establish decision frameworks and evaluate technology, platform reuse, automation, and business outcomes.

• Set engineering standards, design patterns, and best practices.

• Mentor and coach senior engineers, principal engineers, and architects.

• Drive CI/CD, automated testing, observability, resiliency, and AI-assisted development.

• Document architectural decisions and remain engaged throughout implementation.

• Advise technology leadership and collaborate with product, design, operations, architecture, data, Payment Integrity, and business stakeholders.

• Represent Claims Automation in enterprise architecture discussions and strategic planning forums.

⛳️ Requirements

• Over 15 years of progressive experience in software engineering, architecture, platform engineering, or enterprise technology leadership.

• Proven experience in defining architecture for complex, independently managed applications or platforms.

• Capable of defining enterprise technical strategy and translating it into actionable, sequenced roadmaps.

• Experience in designing enterprise-scale distributed systems, APIs, integration patterns, and shared platform capabilities.

• Background in introducing automation, analytics, decision-making, or intelligent capabilities into high-volume operational workflows.

• Ability to evaluate and guide technology-stack decisions for large-scale platforms.

• Proficient in influencing technical decisions and leading large engineering organizations through technical credibility rather than positional authority.

• Experience in spearheading technology transformation in complex, high-volume transaction-processing environments.

• Exceptional communication skills for translating technical strategy into business outcomes and engaging with executive stakeholders.

• Bachelor's degree in Computer Science, Engineering, or a related field, or equivalent experience (19+ years of relevant experience in lieu of degree).

• Preferred: experience with healthcare payer systems, claims processing, Payment Integrity, or regulated transaction-processing environments.

• Preferred: experience in unifying independently developed applications and platforms into a cohesive ecosystem.

• Preferred: experience in integrating AI/ML, intelligent automation, rules engines, analytics, or decision-making platforms into operational workflows.

• Preferred: experience with large-scale legacy or mainframe platforms.

• Preferred: familiarity with COBOL, CICS, DB2, batch processing, HIPAA, CMS, or SOX.

• Preferred: experience in platform engineering, developer experience, or reusable-capability initiatives.

• Preferred: contributions to industry thought leadership, open source, technical publications, or professional communities.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.