Lead Enterprise Architect (FEP Medicare Advantage)

About the Role

This role provides technical leadership, analysis, and design facilitation across business, information, technical, and solution viewpoints within enterprise architecture. Working with the Director of Enterprise Architecture, this position leads the integration of enterprise architecture processes with related organizational processes such as investment, enterprise program, IT portfolio, and project management. The role performs cost-benefit analysis to determine architectural approaches for multi-year business initiatives and architecturally significant projects, incorporating Architectural Trade-off Analysis Method (ATAM) and Cost-Benefit Analysis Method (CBAM).

Key responsibilities include performing top-down, order-of-magnitude estimates for technology development and operational activities, developing estimating models based on historical project costs, and providing subject matter expertise to individual projects on architectural and technology decisions. The role also conducts research on emerging technologies, publishes annual trend reports, and integrates technology acceleration and innovation processes with project management practices and software development lifecycles.

This position specifically 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.

Responsibilities

• 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 major architectural domains: business, information, technical, and system architectures.
• Define multi-year architectural evolution and roadmaps for major products that align with reference architectures.
• Analyze the business strategy of the Association and individual business units to define an IT strategy and enterprise architecture enabling successful execution of business strategies.
• Break down business objectives and strategies into technical initiatives spanning multiple programs, projects, products, and releases.
• Serve as an 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 on architectural and technology topics with 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 to facilitate architectural consistency and business alignment.
• Define architectural and technology standards.
• Establish Architecture Assurance processes and integrate them with project management practices, end-to-end processes, and software development lifecycles.
• Operate the BCBSA Architecture Review Board (ARB) as part of the Architecture Assurance process.
• Develop architectural templates and standard artifacts to facilitate the Architecture Assurance process.
• Follow good documentation practices, producing and managing formal artifacts and writing clean, readable, and standards-compliant architectural documents.
• Review and approve architectural documents.

Requirements

• Bachelor’s Degree in Computer Science, Engineering, Information Systems, Business Administration, or a related field, or equivalent work experience in a similar environment.
• Preferred: Master’s Degree in Computer Science, Information Systems, Business Administration, or Management.
• 10+ years of IT or software development work experience, including enterprise architecture, software and system architecture, business analysis, business process architecture, application system design and implementation, and technical team leadership.
• 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.
• 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.
• 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.

Skills

• 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, preferably in Medicare Advantage.
• Advanced analytical and conceptual skills with the 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.
• Understanding and consistent application of current application development methodologies.
• Strong research skills in emerging technologies and their potential business applications.
• 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, including 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.

Pay

The posted salary range for this position is $162,996.28 to $224,119.88. This job is also eligible for annual bonus incentive pay.

Benefits

• Comprehensive package of benefits including paid time off and 11 holidays.
• Medical, dental, and vision insurance.
• Generous 401(k) matching.
• Lifestyle spending account.
• Additional benefits for eligible employees.