Operations Solution Architect

Overview Overview This role leads operations strategy and service design for Core Administration Business Process as a Service (BPaaS) programs.

You will work closely with health plan executives, operations leaders, and transformation teams to shape future-state operating models, guide modernization strategy, and support sales pursuits.

You Are: A senior health plan operations strategist with deep experience across Core Administration domains.

You understand payer operations end-to-end and can translate complex operational challenges into measurable, scalable BPaaS solutions.

You excel in designing service models, developing modernization roadmaps, and guiding clients through operational transformation.

You are comfortable leading executive workshops, shaping BPaaS value propositions, and bridging the gap between operational realities and modern platform capabilities.

The Opportunity BPaaS Solution Design & Core Admin Modernization Lead service model design and solution blueprinting for health plan Core Administration transformation initiatives.

Assess current-state operations on legacy platforms (e.g., Facets, QNXT, Javelina, QicLink, homegrown) and define transition pathways to BPaaS delivery models on the HealthEdge ecosystem, including HealthRules Payer (HRP).

Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations—with a focus on service delivery efficiency, scalability, and outcomes.

Operational Ecosystem & Service Integration Strategy Define how BPaaS service layers connect across the health plan ecosystem—including care management, provider data management, payment integrity, member engagement, and analytics.

Identify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration into operational service models.

Recommend operating model patterns that reduce administrative burden, improve turnaround times, and drive measurable cost and quality outcomes.

Sales & Pursuit Leadership Support Advisory and Sales teams on strategic BPaaS pursuits, proposals, and RFP responses.

Lead operational discussions with COOs, VP Operations, and business transformation leaders—translating BPaaS capabilities into health plan business outcomes.