Lead Software Developer
About The Position
Alivi is seeking a Lead Software Developer with deep healthcare payer domain expertise to join the CapAdmin platform team. CapAdmin is Alivi’s proprietary claims administration system supporting its Third-Party Administrator (TPA) operations. This hybrid technical-SME leadership role connects engineering execution with payer and claims business knowledge. The role supports the CapAdmin Development Lead and owns architecture, requirements validation, and subject-matter guidance to ensure features are built with complete domain requirements before development begins. The Lead Software Developer serves as an internal SME for payer and TPA workflows, including institutional and professional claim processing, coordination of benefits, utilization management, capitation, eligibility and enrollment, claims adjudication, and EDI standards. The role translates payer business requirements into technical specifications and partners with Operations, Finance, and Compliance to validate claims and capitation logic end to end. The position partners with the CapAdmin Development Lead on architecture, scalability, and platform modernization; leads code reviews with attention to business logic; mentors developers; and contributes to new product-line integrations. It owns requirements completeness, defines acceptance criteria grounded in payer regulations and customer contracts, and works with Business Analysts, QA, and Product to address defects caused by incomplete requirements. The role also collaborates with Operations, payer clients, Architecture, Security, and Data/BI teams.
Requirements
- At least 6 years working inside a payer platform, TPA system, or claims administration software.
- At least 6 years of professional software engineering experience.
- Hands-on experience processing UB04 and CMS-1500 claims.
- Experience with COB rules and logic, including NAIC order of benefits and Medicare secondary payer.
- Experience with Utilization Management workflows.
- Experience with capitation models and reconciliation.
- Experience with EDI transactions 837, 835, 834, 270/271, and 278.
- Working knowledge of CPT, HCPCS, ICD-10, revenue codes, and place-of-service codes.
- Familiarity with CMS, state Medicaid, and commercial payer requirements.
- Strong proficiency in C#/.NET, Java, or similar enterprise programming languages.
- Experience with relational databases such as SQL Server or PostgreSQL and data modeling for claims or payer systems.
- Experience with REST APIs, microservices, and integration patterns.
- Comfort with Agile/Scrum, CI/CD, and modern DevOps practices.
- Ability to mentor engineers and translate domain knowledge for technical and business audiences.
- Strong written and verbal communication skills, including ability to participate in customer- and executive-level conversations.
- Bilingual English/Spanish; Spanish is required.
Nice To Haves
- Familiarity with AWS, including the Redshift/AWS/QuickSight stack.
- Prior technical leadership experience at a TPA, MSO, IPA, or health plan.
- Experience with specialty benefits administration, such as vision, transportation, podiatry, or therapy.
- Familiarity with HITRUST, HIPAA, and HITECH compliance requirements for payer systems.
- Experience supporting Medicaid managed care, such as Sunshine Health, Humana, or Florida Medicaid.
- Background in risk-based contracts, sub-capitation, and value-based care arrangements.
Responsibilities
- Serve as the internal subject-matter expert for payer and TPA workflows, including UB04/CMS-1500 claims, COB, UM, capitation, eligibility and enrollment, claims adjudication, and EDI.
- Translate complex payer business requirements into complete technical specifications before development begins.
- Partner with Operations, Finance, and Compliance to validate claims and capitation logic end to end.
- Partner with the CapAdmin Development Lead to drive architecture, scalability, and platform modernization.
- Lead code reviews, identifying both code-quality issues and payer business-logic errors.
- Mentor mid-level developers on healthcare payer concepts.
- Contribute to designing and implementing new product-line integrations, including Ophthalmology and expanded COB.
- Ensure features have complete payer-domain context before sprint commitment.
- Work with Business Analysts, QA, and Product to address the root causes of defects related to incomplete requirements.
- Define and document acceptance criteria grounded in payer regulations and customer contracts.
- Partner with Operations leadership on claims accuracy, capitation reconciliation, and customer-facing escalations.
- Support technical conversations with payer clients when domain expertise is needed.
- Collaborate with Architecture, Security, and Data/BI teams on enterprise alignment.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
