Operations Solution Architect

This role leads operations strategy and service design for Core Administration Business Process as a Service (BPaaS) programs, working closely with health plan executives, operations leaders, and transformation teams to shape future operating models, guide modernization, and support sales.

Location: Remote – US

Salary: $160,000–$200,000/yr

Responsibilities

• Lead service model design and solution blueprinting for health plan Core Administration transformation initiatives.
• Assess current-state operations on legacy platforms and define transition pathways to BPaaS delivery models.
• Design future-state operating models for claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations.
• Define how BPaaS service layers connect across the health plan ecosystem.
• Identify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration.
• Support sales teams on strategic BPaaS pursuits, proposals, and RFP responses.
• Lead operational discussions with health plan leadership.
• Develop business cases demonstrating cost reduction, operational efficiency, scalability, and compliance.
• Conduct current-state assessments of Core Admin operations, staffing, and process maturity.
• Create modernization roadmaps and platform transition strategies.
• Ensure solutions align with regulatory requirements and standards.
• Mentor team members on operational domains and service design principles.
• Partner with technology teams to ensure operational feasibility.
• Represent advisory in client workshops and strategic forums.

Requirements

• 10–15+ years in health plan operations, Core Administration, or healthcare BPaaS strategy.
• Deep operational expertise across claims, enrollment, billing, benefits administration, UM, A&G, provider, and member services.
• Proven ability to assess operational models and design BPaaS service blueprints.
• Strong familiarity with Core Admin platforms (HealthRules Payer, Facets, QNXT, QicLink, Javelina, or equivalent).
• Strong sales-facing skills: whiteboarding, pursuit support, and executive communication.
• Exceptional analytical, communication, and client-facing presence.

Benefits

• Remote work with travel required for client sessions, workshops, and internal collaboration.
• Competitive salary range of $160,000 to $200,000 per year.
• Inclusive workplace culture.
• Opportunities for professional growth and impact.

Additional Information

• Position is full-time, permanent, and exempt under FLSA.
• Candidates may need to travel and will work across multiple time zones.
• Pre-employment background check required.
• Equal opportunity employer encouraging diversity.