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OverviewThis role leads technology strategy, solution blueprinting, and architecture design for Core Administration modernization programs. You will work closely with payer executives, operations leaders, and technology teams to shape future-state platforms, guide modernization strategy, and support sales pursuits-without direct implementation ownership.

You Are:

A senior technology strategist and solution architect with deep experience across Core Administration systems, preferably HealthRules Payer (HRP). You understand payer operations end-to-end and can translate complex operational challenges into modern, scalable architectures.

You excel in developing solution blueprints, modernization roadmaps, and advisory-led sales support. You are comfortable leading whiteboarding sessions, shaping modernization strategies, and guiding clients through ecosystem and platform transformation.

The Opportunity

Solution Blueprinting & Core Admin Modernization

• Lead solution architecture and blueprinting for payer Core Admin transformation initiatives.
• Assess legacy platforms (e.g. Facets, QNXT, Javelina, QicLink, homegrown) and define migration pathways to modern platforms including HealthRules Payer (HRP).
• Design future-state architecture for claims, enrollment, billing, provider, UM, A&G, benefits admin, and member operations.

Enterprise Technology & Ecosystem Architecture

• Define integration strategy for Core Administration Transformation across CRM, portals, care management, provider data, payment integrity, and data/analytics platforms.
• Recommend modern technology patterns: cloud-native architectures, event-driven messaging, scalable API frameworks.
• Identify opportunities for automation, workflow orchestration, and AI-enabled operational models.

Sales & Pursuit Leadership

• Support Advisory and Sales teams on strategic pursuits, proposals, and RFP responses.
• Lead technical discussions with CIOs, CTOs, technology leaders, and operations executives.
• Develop value cases showing cost, operational, and scalability benefits.

Transformation Advisory

• Conduct current-state assessments of Core Admin and ecosystem technologies.
• Create modernization roadmaps, platform transition strategies, and future-state enterprise architectures.
• Ensure proposed solutions align with operational goals, compliance requirements, and long-term scalability.

Collaboration & Leadership

• Mentor team members on architecture principles, Core Admin domains, HRP concepts, and solution design.
• Partner with delivery/engineering teams to validate feasibility and alignment with modernization strategy.
• Represent Advisory in client workshops, executive sessions, and strategic planning forums.

Qualifications

Required

• 10-15+ years in healthcare payer technology, enterprise architecture, or Core Admin strategy.
• Strong experience with one or more Core Admin platforms (including HealthRules Payer (HRP), Facets, QNXT, QicLink, Javelina, or modern cloud-native platforms).
• Deep understanding of operational domains: claims, enrollment, billing, benefits, UM, A&G, provider, and member services.
• Proven ability to design future-state architectures and transformation blueprints.
• Strong sales-facing skills: whiteboarding, pursuit support, and executive communication.
• Exceptional communication, analytical ability, and client-facing presence.

Preferred

• Experience developing strategies to migrate from legacy platforms to HRP or other modern SaaS/cloud-native Core Admin solutions.
• Familiarity with AI/ML, automation, workflow engines, and digital operations transformation.
• Prior consulting or product-advisory experience with a SI, health plan, or technology vendor.

Location: Remote - USTravel required for client sessions, workshops, and internal collaboration.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. 

Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check.  

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

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**The annual US base salary range for this position is $160,000 to $200,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.