Responsibilities
- Lead engineering projects across healthcare payer systems, including claims processing, eligibility checks, benefits management, and payment infrastructure.
- Work with product and engineering teams to shape system architecture and strategic roadmaps that meet U.S. healthcare regulations and payer requirements.
- Advance the creation and rollout of new features and services tailored to payer environments, including Medicare, Medicaid, and private insurance.
- Ensure reliable integration with external systems such as claims clearinghouses, electronic health records, and federal databases like CMS, adhering to HIPAA standards.
- Apply deep knowledge of healthcare claims workflows, adjudication logic, risk modeling, and utilization review processes.
- Convert business needs into secure, scalable technical designs with strong emphasis on regulatory compliance and data accuracy.
- Manage the transition of outdated systems to modern cloud-based platforms using providers such as AWS, Azure, or GCP.
- Coach development teams in adopting effective software practices, agile workflows, and DevOps principles.
- Assess third-party tools, APIs, and industry standards like HL7, FHIR, and X12 for system compatibility and integration opportunities.
- Monitor evolving healthcare regulations such as the Interoperability Rule and No Surprises Act, and guide product improvements accordingly.
