Lead Software Engineer Healthcare Payer SME — CapAdmin Platform

Duties & Responsibilities

• Healthcare Payer Domain Leadership (Primary Focus)
• Translate complex payer business requirements into clear, complete technical specifications before development begins.
• Partner with Operations, Finance, and Compliance to validate claims and capitation logic end-to-end.
• Technical Leadership
• Partner with the CapAdmin Development Lead to drive architecture, scalability, and platform modernization.
• Mentor mid-level developers on healthcare payer concepts they may not have prior exposure to.
• Contribute to design and implementation of new product line integrations (Ophthalmology, expanded COB, etc.).
• Requirements & Quality Ownership
• Own the "requirements completeness" function — ensuring every feature has full payer-domain context before sprint commitment.
• Define and document acceptance criteria grounded in payer regulations and customer contracts.
• Cross-Functional Collaboration
• Partner with Operations leadership on claims accuracy, capitation reconciliation, and customer-facing escalations.
• Support customer-facing technical conversations with payer clients (Sunshine Health, Humana, etc.) when domain expertise is needed.
• Collaborate with the Architecture, Security, and Data / BI teams on enterprise alignment.

Requirements

• Healthcare Payer / TPA Experience (Non-Negotiable)
• 8+ years of professional software engineering experience
• Strong proficiency in C# / .NET, Java, or similar enterprise languages
• Solid experience with relational databases (SQL Server, PostgreSQL)
• Experience with REST APIs, microservices, and integration patterns
• Familiarity with AWS (Redshift / AWS / QuickSight stack) is a strong plus
• Comfortable with Agile / Scrum, CI/CD, and modern DevOps practices

Preferred Qualifications

• Prior experience at a TPA, MSO, IPA, or health plan in a technical leadership role
• Experience with specialty benefits administration (vision, transportation, podiatry & therapy etc.)
• Familiarity with HITRUST, HIPAA, and HITECH compliance requirements for payer systems
• Experience supporting Medicaid managed care (e.g., Sunshine Health, Humana, Florida Medicaid)
• Background in risk-based contracts, sub-capitation, and value-based care arrangements
• Bilingual (English / Spanish) is a plus given our Miami-based team