Operations Solution Architect

Core 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 spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations.

Operational Ecosystem & Sales Leadership:

• Define how BPaaS service layers connect across the health plan ecosystem including care management, provider data management, and analytics.
• Identify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration into operational service models.
• Support Advisory and Sales teams on strategic BPaaS pursuits, proposals, and RFP responses with strong executive communication.

Transformation Advisory & Collaboration:

• Conduct current-state assessments of Core Admin operations, staffing models, and process maturity.
• Create modernization roadmaps and platform transition strategies grounded in operational realities.
• Lead executive workshops, mentor team members, and partner with technology and delivery teams to ensure operational feasibility.