# Technical Visionary - Claims Automation Ecosystem

**Company**: CVS Health
**Location**: Work from home, TX
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $175,100.00 - $334,750.00
**Category**: Engineering
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Distinguished-Architect--Software-Development---Claims-Processing-Platform_R0924873?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_b93c203e-dc3

## Description

We are seeking a Technical Visionary to lead the development of a Claims Automation ecosystem that brings together intelligent claim assessment and decisioning, workflow and workload orchestration, processor-facing automation, Payment Integrity capabilities, modernized adjudication experiences, and supporting platform services.

The successful candidate will define and drive the shared technical North Star across organisational boundaries, ensuring that independently owned capabilities converge toward a scalable, integrated, and sustainable Claims architecture.

**Key Responsibilities:**

**Technical Vision & Architecture**

- Define and own the end-to-end technical North Star for the Claims Automation and Processor Enablement ecosystem.

- Establish how intelligent claim assessment, decisioning, workflow orchestration, processor-facing automation, Payment Integrity capabilities, and core adjudication services interact across the claim lifecycle.

- Develop and maintain a comprehensive architectural blueprint showing how ecosystem capabilities interact, exchange data, and evolve over time.

- Define integration patterns, APIs, events, and shared services required to create a cohesive and extensible Claims Automation ecosystem.

**Claims Automation & Decisioning**

- Define the architectural approach for applying claim complexity, Payment Integrity risk, business rules, analytics, and intelligent recommendations throughout the claim lifecycle.

- Establish how decision outputs are created, governed, consumed, measured, and improved through operational feedback.

- Ensure automation architecture supports traceability, explainability, auditability, regulatory compliance, and appropriate human oversight.

**Claims Ecosystem Evolution**

- Define the technical evolution of the Claims Automation ecosystem from current-state processing toward the target-state architecture.

- Partner with engineering leaders responsible for legacy and platform modernization to ensure modernization roadmaps enable the future Claims Automation strategy.

- Establish pragmatic transition architectures that allow new and existing capabilities to coexist while the broader ecosystem evolves.

**Transformation Influence & Decision Leadership**

- Challenge entrenched technical assumptions and current-state boundaries when they prevent Claims from achieving strategic outcomes.

- Build evidence-based recommendations that enable technology, product, and business leaders to make difficult investment and architecture decisions.

- Resolve competing technical strategies and drive convergence across organisations with different priorities, roadmaps, and leadership structures.

**Engineering Excellence & Mentorship**

- Establish engineering standards, design patterns, and best practices for capabilities within the Claims Automation ecosystem.

- Mentor and coach senior engineers, principal engineers, and architects to elevate technical capability and strategic thinking.

- Drive adoption of modern engineering practices, including CI/CD, automated testing, observability, resiliency, and AI-assisted development.

**Strategic Partnership & Role Boundaries**

- Serve as a trusted advisor to technology leadership, translating technical strategy into measurable business and operational outcomes.

- Collaborate with product, design, operations, architecture, data, Payment Integrity, and business stakeholders.

- Influence technical direction across multiple organisations without direct authority.

**Required Qualifications:**

- 15+ years of progressive experience in software engineering, architecture, platform engineering, or enterprise technology leadership.

- Demonstrated experience defining architecture across complex, independently owned applications or platforms.

- Strong experience designing enterprise-scale distributed systems, APIs, integration patterns, and shared platform capabilities.

- Experience introducing automation, analytics, decisioning, or intelligent capabilities into high-volume operational workflows.

**Preferred Qualifications:**

- Experience with healthcare payer systems, claims processing, Payment Integrity, or other high-volume regulated transaction-processing environments.

- Experience unifying independently developed applications and platforms into a cohesive ecosystem.

- Experience integrating AI/ML, intelligent automation, rules engines, analytics, or decisioning platforms into operational workflows.

**Education:**

- Bachelor's degree in Computer Science, Engineering, or a related field, or equivalent experience (19+ years of relevant experience in lieu of degree).

**Pay Range:** $175,100.00 - $334,750.00

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## Skills

### Required
- software engineering
- architecture
- platform engineering
- enterprise technology leadership
- distributed systems
- APIs
- integration patterns
- automation
- analytics
- decisioning

### Nice to have
- healthcare payer systems
- claims processing
- Payment Integrity
- AI/ML
- intelligent automation
- rules engines
- decisioning platforms

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Distinguished-Architect--Software-Development---Claims-Processing-Platform_R0924873?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)