Enterprise Architect

Role name: Enterprise Architect

Role Description: Job Description: Enterprise Architect with Medicare-Medicaid Duals experience

Position Summary: The Enterprise Architect is responsible for integrating and optimizing systems and processes supporting Fully Integrated Dual Eligible (FIDE) Special Needs Plans across multiple states. This role ensures seamless coordination between Medicaid and Medicare operations, focusing on claims, eligibility, provider data, compliance, and reporting. The EA partners with business, IT, and compliance teams to deliver scalable, compliant, and efficient solutions.

Key Responsibilities:

1. Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
2. Understand end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
3. Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
4. Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
5. Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
6. Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
7. Support the implementation of new markets and retrofit best practices into existing FIDE programs.

Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, or related field (Master’s preferred).
• 7+ years of experience in healthcare IT, with at least 1 year in Medicaid/Medicare duals or FIDE programs.
• Strong knowledge of claims, eligibility, provider, and compliance systems.
• Experience with system integration, data management, and regulatory reporting.

Competencies: Claims Processing - Life and Pensions, Healthcare: Pharmacy, Healthcare Payer

Experience (Years): 10 & Above

Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without discrimination. We promote and support a diverse workforce across all levels in the company.