Lead Enterprise Architect (FEP Medicare Advantage)

This role is responsible for providing technical leadership, analysis and design facilitation across business, information, technical and solution viewpoints and enterprise architecture. In conjunction with the Director, Enterprise Architecture, this role is responsible for leading the effective integration of the Enterprise Architecture processes with other related processes (i.e., investment, enterprise program, IT portfolio and project management) in the organization. This role performs cost-benefit analysis to determine appropriate architectural approaches for multiyear business initiatives and architecturally significant projects. Incorporate Architectural Trade-off Analysis Method (ATAM) and Cost-Benefit Analysis Method (CBAM). Additionally, it will perform top-down, order-of-magnitude estimates for technology development and operational activities; develop and refine order-of-magnitude estimating models based on previous project actual costs and trends to improve accuracy of estimates; provide Subject Matter Expert (SME) services to individual projects in the areas of architectural and technology selection decisions; conduct research in emerging technologies and continuously identify technologies with high-potential business value and specify their appropriate usage in developing business solutions; conduct technology trends studies and publish trend reports on an annual basis, develop and integrate technology acceleration and innovation processes with the overall project management practices, E2E process, and software development lifecycle.

This specific role leads enterprise architecture for BCBSA's Medicare Advantage (MA) business, defining multi-year technology roadmaps, reference architectures, and standards that enable scalable, compliant MA capabilities. The ideal candidate brings deep MA technology experience — including data exchange, prior authorization, risk adjustment, and CMS interoperability — and translates business strategy into sound architectural decisions. An AI-first mindset is essential, with the ability to evaluate AI tools for fit, scalability, and responsible use in a regulated healthcare environment.

• Analyze objectives and goals to identify common patterns, leverage points and consistent business needs across multiple business units and initiatives. Develop reference architectures and models for the major architectural domains: business, information, technical, and system architectures. Define multi-year architectural evolution and roadmaps for major products that align with the reference architectures.
• Analyze the business strategy of the Association and of the individual business units to define an IT strategy and enterprise architecture that enables the successful execution of the business strategies. Break down the business objectives and strategies into technical initiatives spanning multiple programs, projects, products, and releases.
• Serve as expert level advisor to business and IT management on architectural and technology topics, best practices, risks and opportunities. Represent BCBSA’s architectural vision and strategic technology positioning at Association, Plan, and Industry-wide forums and events. Write and publish whitepapers and positioning documents representing BCBSA’s vision and opinion on architectural and technology topics with Blue system-wide and industry-wide significance.
• Provide clear direction, coaching and support to business and technical staff on project teams. Recommend, define, and establish cross functional organizational structures that facilitate the successful achievement of architectural consistency and business alignment.
• Define architectural and technology standards. Establish Architecture Assurance processes and integrate them with the overall Association project management practices, E2E process, and software development lifecycle. Operate the BCBSA Architecture Review Board (ARB) as part of the Architecture Assurance process. Develop architectural templates and other standard artifacts to facilitate the Architecture Assurance process. Follow good documentation practices including producing and managing formal artifacts, as well as writing clean, readable, and standards-compliant architectural artifacts.
• Review and approve architectural documents

The posting range for this position is:

162,996.28 - 224,119.88

Qualifications:

Education

• Required Bachelor's Degree in Computer Science or Engineering, Information Systems, Business Administration, Engineering or Science field, or equivalent work experience in similar work environment.
• Preferred Master's Degree in Computer Science, Information Systems, Business Administration, or Management

Experience

• Required: 10+ Years IT or software development work experience including enterprise architecture, software and system architecture, business analysis and business process architecture, application system design and implementation, technical team leadership
• Required: 5+ years of enterprise architecture experience designing and evolving end-to-end Medicare Advantage technology ecosystems, including reference architectures spanning enrollment, bid/pricing, core administration (e.g., claims/Facets-type platforms), encounter data, risk adjustment, Stars/quality, utilization management, and care/behavioral health management.
• Required: Demonstrated experience defining multi-year MA architectural roadmaps that align with CMS regulatory cycles (e.g., AEP readiness, bid submission, audit/compliance timing) and dual CMS/OPM oversight models where applicable.
• Required: Demonstrated experience applying an AI-first approach to architecture and solution design, including evaluating and embedding AI/ML and generative AI capabilities into reference architectures and technology roadmaps to drive efficiency, innovation, and business value.
• Preferred: Demonstrated experience architecting solutions within the Federal Employee Program (FEP) ecosystem, including Office of Personnel Management (OPM) oversight requirements distinct from CMS.

Knowledge Skills and Abilities

• In-depth knowledge of state-of-the-art programming languages and object oriented approaches in designing, coding, testing and debugging programs
• Extensive use of Project Management methodologies
• Expert level understanding of the health insurance industry preferred
• Advanced analytical and conceptual skills
• Ability to create original concepts/theories for various projects
• Advanced leadership skills
• Ability to perform cost benefit analysis, business case development, and financial justification
• Excellent presentation and communication skills
• Understands and consistently applies the attributes and processes of current application development methodologies
• Strong research skills in emerging technologies and possible application to the business
• Ability to maintain key relationships to achieve business objectives
• Working knowledge of Medicare Advantage data exchange standards and core platforms (e.g., TriZetto Facets or comparable administration systems, ADT/clinical data exchange, prior authorization, payment integrity, and real-time claims adjudication architectures).
• Ability to architect for emerging MA capability areas (e.g., intelligent provider navigation, real-time prior authorization, AI-driven Stars/quality improvement) and incorporate them into multi-year technology roadmaps.
• Ability to evaluate emerging AI tools and platforms for architectural fit, scalability, and responsible AI considerations (e.g., data privacy, model governance, explainability) within a regulated healthcare environment.
• MA financial and risk-adjustment expertise. Working knowledge of MA capitation, full-risk vs. risk-share/80-20 structures, EGWP wrap arrangements, and risk adjustment.
• Familiarity with CMS-mandated interoperability and data exchange requirements