Job Description
Position Summary
We are seeking an experienced Solution Architect to lead a large-scale healthcare EDI modernization initiative involving migration and transformation of legacy transaction processing capabilities to a modern Edifecs-based platform. The architect will drive end-to-end solution architecture across Edifecs, .NET, Data Platforms, APIs, Cloud, and Healthcare EDI transactions, ensuring scalable, secure, and high-performing solutions.
The ideal candidate should possess deep expertise in healthcare EDI transactions (837/857/835/270/271/278), Edifecs products, enterprise integration patterns, .NET architecture, and modern data platforms.
Key Responsibilities
Architecture & Solution Design
Own end-to-end architecture for EDI modernization initiatives.
Define target-state architecture, integration patterns, and modernization roadmap.
Design scalable solutions leveraging Edifecs, APIs, microservices, cloud, and data platforms.
Establish architecture standards, coding guidelines, and governance processes.
Drive architecture reviews and technical solution approvals.
Edifecs & Healthcare EDI
Architect solutions using:
Edifecs SpecBuilder
MapBuilder
XEngine
XEServer
STP
Transaction Management (TM)
Design transaction processing for:
837 Professional, Institutional, Dental
857 and other X12 transactions
999, 277CA acknowledgements
EBR and exception processing
Define trading partner onboarding and transaction monitoring strategies.
.NET & Integration Architecture
Design modern .NET-based services and APIs.
Lead modernization of legacy .NET applications.
Define microservices architecture and event-driven integration patterns.
Architect REST APIs and enterprise integration solutions.
Drive CI/CD and DevSecOps adoption.
Data & Analytics Architecture
Define enterprise data architecture supporting EDI processing.
Design data ingestion, transformation, validation, and reconciliation frameworks.
Architect data models, operational reporting, and audit capabilities.
Design integrations with Kafka, data lakes, and analytics platforms.
Enable monitoring, operational dashboards, and business reporting.
Cloud & Platform Engineering
Design cloud-native architectures on Azure/AWS.
Define scalability, resiliency, disaster recovery, and security controls.
Establish observability using monitoring and logging platforms.
Drive platform performance optimization and capacity planning.
Stakeholder Management
Partner with business, operations, product owners, and client stakeholders.
Lead technical workshops and architecture discussions.
Mentor development teams and provide technical leadership.
Support estimation, product roadmap planning, and solution proposals.
Required Qualifications
Bachelor's or Master's degree in Computer Science, Engineering, or related discipline.
15-20+ years of IT experience with 5+ years in Solution/Enterprise Architecture.
Strong experience in healthcare payer/provider ecosystems.
Extensive experience with Edifecs implementations and modernization programs.
Expertise in healthcare EDI/X12 transactions including 837, 857, 835, 270/271, and 278.
Strong hands-on experience with:
C#
.NET Core / .NET 8+
ASP.NET Web APIs
Microservices
SQL Server
Experience with Azure and/or AWS cloud platforms.
Strong understanding of API-led and event-driven architectures.
Experience with Kafka or enterprise messaging platforms.
Knowledge of architecture frameworks and governance models.
Preferred Qualifications
Experience with large-scale payer modernization programs.
Experience in claims processing and adjudication systems.
Exposure to Databricks, Snowflake, Azure Data Platform, or enterprise data lakes.
Experience with healthcare interoperability standards (FHIR, HL7).
Familiarity with Power BI and operational reporting solutions.
TOGAF, Azure Architect, AWS Architect, or similar certifications.
Experience leading globally distributed delivery teams.
Key Skills
Domain
Healthcare Payer
Claims Processing
EDI/X12
837 / 857 Transactions
Trading Partner Management
Edifecs
SpecBuilder
MapBuilder
XEngine
XEServer
STP
TM
Technology
C#
.NET Core / .NET 8+
REST APIs
Microservices
Kafka
SQL Server
Azure / AWS
Data
Data Architecture
Data Modeling
ETL/ELT
Data Governance
Reporting & Analytics
Architecture
Solution Architecture
Integration Architecture
Enterprise Architecture
Cloud Architecture
DevSecOps
Nice-to-Have for Humana 837/857 Modernization
Experience modernizing legacy EDI platforms to Edifecs.
Experience integrating Edifecs with .NET-based services and APIs.
Experience designing claims intake, validation, routing, reconciliation, acknowledgement, and monitoring solutions.
Experience with healthcare operational reporting, audit, compliance, and transaction observability.
