[Remote] Operations Solution Architect

Note: The job is a remote job and is open to candidates in USA. HealthEdge is a company focused on healthcare technology solutions, and they are seeking an Operations Solution Architect to lead operations strategy and service design for Core Administration BPaaS programs. The role involves collaborating with health plan executives and transformation teams to create future-state operating models and support sales pursuits.ResponsibilitiesLead service model design and solution blueprinting for health plan Core Administration transformation initiativesAssess current-state operations on legacy platforms (e.g., Facets, QNXT, Javelina, QicLink, homegrown) and define transition pathways to BPaaS delivery models on the HealthEdge ecosystem, including HealthRules Payer (HRP)Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations—with a focus on service delivery efficiency, scalability, and outcomesDefine how BPaaS service layers connect across the health plan ecosystem—including care management, provider data management, payment integrity, member engagement, and analyticsIdentify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration into operational service modelsRecommend operating model patterns that reduce administrative burden, improve turnaround times, and drive measurable cost and quality outcomesSupport Advisory and Sales teams on strategic BPaaS pursuits, proposals, and RFP responsesLead operational discussions with COOs, VP Operations, and business transformation leaders—translating BPaaS capabilities into health plan business outcomesDevelop business cases demonstrating cost reduction, operational efficiency, scalability, and compliance improvementsConduct current-state assessments of Core Admin operations, staffing models, and process maturityCreate modernization roadmaps and platform transition strategies grounded in operational realities and health plan business prioritiesEnsure proposed BPaaS solutions align with regulatory requirements, accreditation standards, and long-term operational scalabilityMentor team members on Core Admin operational domains, BPaaS service design principles, and health plan business contextPartner with technology and delivery teams to ensure operational feasibility and alignment with service model commitmentsRepresent Advisory in client workshops, executive sessions, and strategic planning forumsSkills10–15+ years in health plan operations, Core Administration, or healthcare BPaaS strategyDeep operational expertise across one or more Core Admin domains: claims, enrollment, billing, benefits administration, UM, A&G, provider, and member servicesProven ability to assess operational models and design future-state BPaaS service blueprintsStrong familiarity with Core Admin platforms (HealthRules Payer, Facets, QNXT, QicLink, Javelina, or equivalent)Strong sales-facing skills: whiteboarding, pursuit support, and executive communication with health plan leadershipExceptional analytical, communication, and client-facing presenceExperience leading or advising on migrations from legacy platforms to modern SaaS or BPaaS delivery modelsFamiliarity with AI/ML, intelligent automation, and digital operations transformation within health plan settingsPrior consulting, managed services, or advisory experience with a health plan, SI, or BPaaS vendorCompany OverviewHealthEdge Software offers benefits administration and care management software solutions. It was founded in 2004, and is headquartered in Burlington, Massachusetts, USA, with a workforce of 1001-5000 employees. Its website is http://www.healthedge.com.Company H1B SponsorshipHealthEdge has a track record of offering H1B sponsorships, with 10 in 2026, 45 in 2025, 37 in 2024, 35 in 2023, 56 in 2022, 35 in 2021, 34 in 2020. Please note that this does not guarantee sponsorship for this specific role.