Distinguished Architect, Software Development – Claims Automation and Processor Enablement

CVS Health • Work At Home-Texas, TX

8d • $175,100 - $334,750

About The Position

CVS Health is seeking a Distinguished Architect, Software Development to serve as the senior technical leader for the architecture and evolution of an enterprise Claims Automation and Processor Enablement ecosystem. The ecosystem brings together intelligent claim assessment and decisioning, workflow and workload orchestration, processor-facing automation, Payment Integrity capabilities, modernized adjudication experiences, and supporting platform services. Its objective is to improve automation, enable earlier and more informed intervention, and transform how claims are evaluated, routed, processed, and resolved across all lines of business.

The role defines and drives a shared technical North Star across independently owned engineering and product organizations, guiding their capabilities toward a scalable, integrated, and sustainable Claims architecture. It establishes the architectural roadmap and target state, partners with leaders modernizing underlying legacy platforms, and helps ensure those strategies support future Claims processing while maintaining operational stability for mission-critical processing.

This is a highly autonomous individual contributor role reporting directly to technology leadership. It operates at the intersection of technical expertise, enterprise strategy, engineering execution, and business impact. The position influences technical direction across organizations without direct authority and remains engaged through implementation to help ensure delivery decisions preserve the intended architecture and outcomes.

Requirements

• 15+ years of progressive experience in software engineering, architecture, platform engineering, or enterprise technology leadership.
• Demonstrated experience defining architecture across complex, independently owned applications or platforms.
• Demonstrated ability to define enterprise technical strategy and translate it into actionable, sequenced roadmaps.
• Strong experience designing enterprise-scale distributed systems, APIs, integration patterns, and shared platform capabilities.
• Experience introducing automation, analytics, decisioning, or intelligent capabilities into high-volume operational workflows.
• Proven ability to evaluate and guide technology-stack decisions for large-scale platforms.
• Proven ability to influence technical decisions and lead large engineering organizations through technical credibility rather than positional authority.
• Experience leading technology transformation in complex, high-volume transaction-processing environments.
• Exceptional communication skills, including translating technical strategy into business outcomes and engaging executive stakeholders.
• Bachelor's degree in Computer Science, Engineering, or a related field, or equivalent experience (19+ years of relevant experience in lieu of degree).

Nice To Haves

• Experience with healthcare payer systems, claims processing, Payment Integrity, or other high-volume regulated transaction-processing environments.
• Experience unifying independently developed applications and platforms into a cohesive ecosystem.
• Experience integrating AI/ML, intelligent automation, rules engines, analytics, or decisioning platforms into operational workflows.
• Experience with large-scale legacy or mainframe platforms and designing modern capabilities that coexist with or progressively decouple from them.
• Familiarity with COBOL, CICS, DB2, batch processing, or comparable legacy transaction-processing technologies.
• Familiarity with regulatory and compliance environments such as HIPAA, CMS, or SOX.
• Experience building or leading platform-engineering, developer-experience, or reusable-capability initiatives.
• Contributions to industry thought leadership, open source, technical publications, or professional communities.

Responsibilities

• Define and own the end-to-end technical North Star and architectural roadmap for the Claims Automation and Processor Enablement ecosystem.
• Establish how intelligent claim assessment, decisioning, workflow orchestration, processor-facing automation, Payment Integrity capabilities, and core adjudication services interact across the claim lifecycle.
• Define capability boundaries across independently owned products and platforms, and develop a blueprint showing how capabilities interact, exchange data, and evolve.
• Identify overlapping or duplicative capabilities and drive decisions about convergence, reuse, consolidation, or purposeful separation.
• Define integration patterns, APIs, events, and shared services for a cohesive and extensible Claims Automation ecosystem.
• Evaluate and guide technology decisions based on business outcomes, engineering suitability, operational risk, enterprise direction, vendor maturity, talent availability, and total cost of ownership.
• Define how claim complexity, Payment Integrity risk, business rules, analytics, and intelligent recommendations are applied throughout the claim lifecycle.
• Establish how decision outputs are created, governed, consumed, measured, and improved through operational feedback.
• Define the interactions among straight-through processing, automated intervention, vendor routing, Payment Integrity review, and processor-assisted adjudication.
• Ensure automation is traceable, explainable, auditable, compliant, and appropriately overseen by people; guide responsible adoption of AI-assisted capabilities.
• Establish reusable automation and decisioning capabilities that reduce duplicated solutions across applications and business areas.
• Define the ecosystem’s evolution from current-state processing to the target architecture, including transition architectures that allow old and new capabilities to coexist.
• Partner with engineering leaders on legacy and platform modernization roadmaps, and influence modernization priorities where existing platform constraints limit automation or efficiency.
• Define architectural seams and integration models that allow new capabilities to evolve independently of systems of record where appropriate.
• Preserve reliability, performance, traceability, accuracy, and regulatory requirements for mission-critical Claims processing.
• Challenge technical assumptions and current-state boundaries that impede strategic outcomes; develop evidence-based recommendations for investment and architecture decisions.
• Resolve competing technical strategies and drive convergence across organizations with differing priorities and leadership structures.
• Establish decision frameworks that enable consistent team choices without requiring centralized review of every implementation.
• Measure success through observable changes in technology decisions, platform convergence, reuse, automation outcomes, and business impact.
• Establish engineering standards, design patterns, and best practices; mentor and coach senior engineers, principal engineers, and architects.
• Promote modern engineering practices, including CI/CD, automated testing, observability, resiliency, and AI-assisted development, as well as continuous improvement, innovation, reuse, and knowledge sharing.
• Document and institutionalize architectural decisions, tradeoffs, and principles, and remain engaged through implementation to validate alignment with intended architecture and outcomes.
• Advise technology leadership by translating technical strategy into measurable business and operational outcomes; collaborate with product, design, operations, architecture, data, Payment Integrity, and business stakeholders.
• Represent Claims Automation in enterprise architecture discussions and strategic planning, and provide requirements and architectural guidance to platform and legacy modernization strategies without owning the broader mainframe modernization agenda.

Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base pay.
• Award target in the company’s equity award program.
• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Principal