Distinguished Architect, Software Development – Claims Automation and Processor Enablement

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary:

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.

This ecosystem will bring together intelligent claim assessment and decisioning, workflow and workload orchestration, processor-facing automation, Payment Integrity capabilities, modernized adjudication experiences, and supporting platform services. The objective is to create a cohesive technical direction that improves automation, enables earlier and more informed intervention, and transforms how claims are evaluated, routed, processed, and resolved across all lines of business.

Components of this ecosystem are owned by different engineering and product organizations and will evolve at different rates. This role will define and drive the shared technical North Star across organizational boundaries, ensuring that independently owned capabilities converge toward a scalable, integrated, and sustainable Claims architecture.

As the technical visionary for this initiative, you will define the architectural roadmap for the Claims Automation ecosystem; establish how intelligent automation, decisioning, workflow, processor experiences, and core claims capabilities work together; and guide engineering organizations toward a cohesive target state. You will partner closely with engineering and architecture leaders responsible for modernization of underlying legacy platforms, ensuring those strategies enable the future Claims processing model while maintaining operational stability for mission-critical processing.

This is a highly autonomous individual contributor role reporting directly to technology leadership. You will operate at the intersection of deep technical expertise, enterprise strategy, engineering execution, and business impact.

Key Responsibilities:

Technical Vision & Architecture

• Define and own the end-to-end technical North Star 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.

• Establish clear capability boundaries across independently owned products and platforms without assuming that current organizational or application boundaries represent the future-state architecture.

• Define how automation, analytics, business rules, AI-assisted recommendations, and human intervention work together to improve Claims processing.

• Develop and maintain a comprehensive architectural blueprint showing how ecosystem capabilities interact, exchange data, and evolve over time.

• Identify overlapping or duplicative capabilities and drive decisions regarding convergence, reuse, consolidation, or purposeful separation.

• Define integration patterns, APIs, events, and shared services required to create 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.

Claims Automation & Decisioning

• Define the architectural approach for applying claim complexity, Payment Integrity risk, business rules, analytics, and intelligent recommendations throughout the claim lifecycle.

• Establish how decision outputs are created, governed, consumed, measured, and improved through operational feedback.

• Define the interaction among straight-through processing, automated intervention, vendor routing, Payment Integrity review, and processor-assisted adjudication.

• Ensure automation architecture supports traceability, explainability, auditability, regulatory compliance, and appropriate human oversight.

• Guide the responsible introduction of AI-assisted capabilities where they improve processor effectiveness, decision quality, or operational efficiency.

• Establish reusable automation and decisioning capabilities that prevent individual applications or business areas from independently recreating similar solutions.

Claims Ecosystem Evolution

• Define the technical evolution of the Claims Automation ecosystem from current-state processing toward the target-state architecture.

• Partner with engineering leaders responsible for legacy and platform modernization to ensure modernization roadmaps enable the future Claims Automation strategy.

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