Role Description We are seeking an experienced AI Solutions Architect to design and deliver artificial intelligence, machine learning, and generative AI solutions for health plan clients. This role will partner with payer executives, data leaders, and engineering teams to translate business challenges into scalable AI solutions. The ideal candidate has deep knowledge of health plan operations, payer data ecosystems, cloud architecture, analytics platforms, and responsible AI practices. This person will lead solution design across areas such as: Member engagement Care management Utilization management Claims operations Risk adjustment Stars Quality Provider network optimization Administrative automation Location: Remote role to be located in the US. If you are a proven AI leader with deep healthcare Payer expertise—and a passion for transforming healthcare through technology—this is an opportunity to shape the future of our business. What You’ll Do 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. Qualifications 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. Requirements 8+ years of experience in designing and developing AI/ML solutions. 4+ years of experience in healthcare Payer technology, consulting, or systems integration. Benefits Medical, dental, and vision insurance Flexible spending or health savings account Life and AD
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