Note: The job is a remote job and is open to candidates in USA. Infinite Computer Solutions is seeking a Healthcare Solutions Architect with deep product knowledge across Benefits Configuration, Claims, and Member/Provider data. The role involves owning configuration, defect resolution, and test validation across the core healthcare administration platform while collaborating with business stakeholders.
Responsibilities
- Translate EOC, SBC, and underwriting/plan documents into Benefit Plan, Product, Package, and Subscriber/Group configuration
- Configure and validate accumulators, cost-share logic (copay/coinsurance/deductible), riders, and exclusions
- Configure and maintain claims adjudication logic, including claim edits, pend/suspend criteria, and auto-adjudication rules
- Support ITS (BlueCard) host and home claim processing, including how local benefit and provider configuration interacts with Association inter-plan programs
- Perform root-cause analysis on claims defects spanning benefit, provider, and pricing configuration, including ITS-related discrepancies
- Configure and maintain Member/Subscriber/Group enrollment and eligibility, and Provider/Network contracting and demographics
- Validate that member eligibility and provider contract terms correctly drive claims pricing and adjudication, including TriZetto pricing/network product behavior
- Support EDI 834 (enrollment) and 837/835 (claims/remittance) transactions, partnering with integration teams on defects
- Lead test script design and execution across benefit, claims, and member/provider configuration for new plan years and releases
- Support open enrollment and annual renewal cycles, including configuration freeze coordination and post-go-live triage
- Maintain configuration documentation and standards across all three domains to support audits and knowledge transfer
- Work directly with business stakeholders across multiple business areas during US business hours, given the cross-functional and time-sensitive nature of plan and claims support
Skills
- 5+ years of hands-on healthcare payer configuration experience spanning Benefits/Product, Claims, and Member/Provider domains
- Deep working knowledge of Benefit Plan, Product, Claims, Membership, and Provider/Network components
- Hands-on ITS (BlueCard) experience and working knowledge of how local configuration interacts with the BCBS Association/inter-plan environment—a critical, hard-to-source skill for this engagement
- Strong product and benefits configuration knowledge; ideally complemented by pricing and network product experience (TriZetto NetworX/pricing products). Candidates with depth on one side and working knowledge of the other are strongly preferred
- Strong understanding of the full plan-to-pay lifecycle: benefit design → enrollment/eligibility → claims adjudication
- Experience with EDI 834, 837, and 835 transaction standards
- Strong SQL skills for configuration validation, defect investigation, and data analysis
- Experience supporting Medicare Advantage, Medicaid, Commercial, or ASO lines of business
- Excellent documentation skills, including configuration specifications, decision logs, and test evidence
- Relevant certifications in Benefits, Claims, Membership, Provider, or Healthcare Administration are strongly preferred
- Must be based onshore (US) and available during US business hours for direct business engagement; this role is not eligible for offshore delegation
- Direct BCBS Plan or BCBS Association/ITS experience
- Experience with NetworX Pricer or NetworX Modeler
- Exposure to Provider Data Management (PDM) platforms supporting provider/network data
- Experience in a vendor remediation or vendor-to-client transition engagement
- Familiarity with CMS network adequacy and No Surprises Act provider directory requirements
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