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Solution Architect in Healthcare
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Tata Consultancy Services Limited
Dallas, TX (In Person)
$163,050 Salary, Full-Time
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Job Description
The Solution Architect is responsible for leading large-scale U.S. healthcare payer contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility. This role owns end-to-end delivery excellence including SLAs, regulatory compliance, financial performance, workforce productivity, and transformation initiatives across Commercial, Medicare, and Medicaid lines of business. The role serves as a senior client-facing leader managing complex multi-LOB healthcare operations while driving cost optimization, quality, and AI-led transformation.
Responsibilities and Duties:
- Provide hands on leadership for 200 - 400+ FTE U.S. healthcare contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility
- Act as a U.S. payer domain SME with deep understanding of member and provider journeys
- Own end to end KPIs and SLAs including AHT, ASA, FCR, quality, accuracy, grievance TAT, and appeals resolution
- Ensure compliance with U.S. healthcare regulations including HIPAA, CMS, Medicare, Medicaid, ACA, and state mandates
- Lead governance with U.S. payer leadership across Operations, CX, Compliance, and Medical Management
- Drive cost to serve reduction through workforce optimization, automation, and AI led interventions
- Lead U.S. healthcare transformation initiatives including digital self service, contact reduction, intelligent routing, and agent assist
- Proactively identify and mitigate operational, regulatory, and compliance risks
- Support U.S. healthcare pursuits and expansions with SME ownership for solutioning, pricing, and operating model design
- Own delivery financials including budgeting, productivity targets, and P&L performance
- Build leadership capability across Managers and Senior Managers and drive a high performance delivery culture
Qualifications:
- Bachelor's or master's degree in business administration or related discipline
- 13+ years BPO and contact center delivery operations
- 10+ years in U.S. healthcare contact center leadership roles
- Mandatory experience in U.S. Member Services across Commercial, Medicare, or Medicaid
- Strong exposure to Provider Services and payer back-office integration
- Hands-on experience with payer platforms such as Facets, QNXT, WGS, PEGA, and portals
- Strong knowledge of CMS audits, HEDIS, STAR ratings, and G&A processes
- Lean Six Sigma Green or Black Belt Certification preferred