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.
• Define architectural seams and integration models that allow new Claims Automation capabilities to evolve independently of underlying systems of record where appropriate.
• Identify constraints within existing platforms that limit automation, decisioning, processor experience, or operational efficiency, and influence modernization priorities accordingly.
• Establish pragmatic transition architectures that allow new and existing capabilities to coexist while the broader ecosystem evolves.
• Ensure architectural decisions preserve the reliability, performance, traceability, accuracy, and regulatory requirements of mission-critical Claims processing.

Transformation Influence & Decision Leadership

• Challenge entrenched technical assumptions and current-state boundaries when they prevent Claims from achieving strategic outcomes.
• Build evidence-based recommendations that enable technology, product, and business leaders to make difficult investment and architecture decisions.
• Resolve competing technical strategies and drive convergence across organizations with different priorities, roadmaps, and leadership structures.
• Establish decision frameworks that allow teams to make consistent choices without requiring centralized review of every implementation.
• Measure success through observable changes in technology decisions, platform convergence, reuse, automation outcomes, and business impact, not solely through publication of architecture artifacts.
• Operate as an agent of change who can create constructive tension while maintaining trust with business, product, architecture, and engineering leaders.

Engineering Excellence & Mentorship

• Establish engineering standards, design patterns, and best practices for capabilities within the Claims Automation ecosystem.
• Mentor and coach senior engineers, principal engineers, and architects to elevate technical capability and strategic thinking.
• Drive adoption of modern engineering practices, including CI/CD, automated testing, observability, resiliency, and AI-assisted development.
• Promote a culture of continuous improvement, innovation, reuse, and knowledge sharing.
• Ensure architectural decisions, tradeoffs, and principles are documented and institutionalized to reduce reliance on tribal knowledge.
• Remain engaged through implementation to validate that delivery decisions preserve the intended architecture and business outcomes.

Strategic Partnership & Role Boundaries

• Serve as a trusted advisor to technology leadership, translating technical strategy into measurable business and operational outcomes.
• Collaborate with product, design, operations, architecture, data, Payment Integrity, and business stakeholders.
• Influence technical direction across multiple organizations without direct authority.
• Represent Claims Automation in enterprise architecture discussions and strategic planning forums.
• Partner with engineering executives and application owners who retain accountability for engineering capacity, delivery commitments, operational results, and modernization execution.
• Provide Claims Automation requirements and architectural guidance into underlying platform and legacy modernization strategies without owning the broader mainframe modernization agenda.

Required Qualifications:

• 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 an 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 with the ability to translate technical strategy into business outcomes and engage executive stakeholders.

Preferred Qualifications:

• 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 working 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.

Education:

Bachelor's degree in Computer Science, Engineering, or a related field, or equivalent experience (19+ years of relevant experience in lieu of degree).

Pay Range

The typical pay range for this role is:

$175,100.00 - $334,750.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.