Solution Architect – Facets & Medicaid Regulatory Transformation

Job Description/ Responsibilities

•            Own end-to-end technical architecture for state-specific Medicaid regulatory changes.

•            Assess regulatory impacts across:

•            Facets

•            Mainframe platforms

•            Java/J2EE applications

•            DataStage

•            Talend/TalendWorks

•            APIs and integration services

•            Databases

•            Batch platforms

•            Upstream and downstream applications

•            Determine the appropriate implementation approach across Facets configuration, Mainframe development, Java development, ETL/data changes, integration changes, or surrounding applications.

•            Design solutions supporting:

•            Member enrollment

•            Eligibility

•            Benefits

•            Claims adjudication

•            Claims pricing

•            Claims payment

•            Regulatory edits

•            Medicare/Medicaid coordination

•            Develop architecture patterns that allow common capabilities to be reused while supporting state-specific Medicaid variations.

•            Perform regulatory impact assessments and identify cross-platform dependencies.

•            Provide technical leadership to Mainframe, Java, Facets, ETL, and QA teams.

•            Conduct architecture reviews, technical quality assessments, and production-readiness reviews.

•            Identify design gaps, integration risks, data impacts, and downstream regulatory impacts.

•            Partner with Medicaid regulatory SMEs, business analysts, product owners, engineering, and QA teams.

Required Experience

•            Deep TriZetto Facets architecture and implementation experience.

•            Strong Mainframe architecture and application knowledge, including COBOL/JCL/DB2/CICS or comparable technologies.

•            Strong Java/J2EE architecture and engineering knowledge.

•            Experience with IBM DataStage.

•            Experience with Talend/TalendWorks.

•            Experience with enterprise APIs, integrations, batch systems, databases, and data architecture.

•            Strong knowledge of Medicaid managed care and state-specific regulations.

•            Good understanding of Medicare and Medicaid plan operations.

•            Deep understanding of membership/eligibility and end-to-end claims processing.

•            Experience architecting regulatory-driven changes across multiple integrated applications."                                                                   

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