JOB SUMMARY
Veradigm is building Health Network Architecture (HNA), an emerging platform at the center of the company that brings its clinical, payer, and Life Sciences businesses onto shared foundations. This role defines and delivers the clinical and payer data foundation for Veradigm's payer products on HNA: how data comes in, the shared definitions and contracts it is modeled with, and how products, analytics, AI features, and partners access it. It is equally instrumental in delivering the product and platform outcomes that depend on that data across risk adjustment, quality, care coordination, prior authorization, and CMS interoperability. This role decides the shared clinical and payer data definitions, contracts, and API/big data access patterns for payer products. Product teams decide how they build on them, and HNA platform architecture owns the overall platform design. The role works inside delivery with those teams and sees the hardest data problems through to production. Veradigm's goal is for AI to be a first-class part of how it builds and what it delivers to clients. This role helps achieve this: it designs data that AI features can rely on and uses AI in its own engineering work. It is a hands-on individual contributor role, about 25% building reference implementations and shared primitives, with the rest spent on design, design review, and working alongside Product and engineering teams in the US and India.
WHY THIS ROLE MATTERS
Payers and providers each hold part of a member's story, and the gaps between them show up as delayed care, duplicated work, and decisions made on stale data. Veradigm's payer products close those gaps, giving health plans a complete, current view of every member and giving providers faster answers from the plans they work with. The data foundation this role designs is what that view is built on.
ESSENTIAL FUNCTIONS/MAJOR JOB RESPONSIBILITIES
Clinical and payer data ingestion
- Design the ingestion framework for rapid ingestion of claims, remittance, enrollment, eligibility, pharmacy, lab, ADT, and clinical documents across X12, HL7, FHIR, and file feeds.
- Establish standards for validation, reconciliation, provenance, observability, and safe reprocessing so data quality and delivery can be measured end to end.
- Define the architecture and sequence for moving existing payer feeds onto HNA without disrupting customers.
Data modeling and access patterns
- Design the shared clinical and payer data definitions and contracts that payer products on HNA build from.
- Enable payer products to reuse shared definitions, contracts, and services while supporting their distinct workflows.
- Run model governance: versioning, schema evolution, extension approvals, and data contracts with producing and consuming teams.
- Define when products and partners use synchronous APIs, events, bulk exchange, or analytical access, including FHIR-based interfaces where appropriate.
- Design access with Security and Privacy to meet HIPAA minimum-necessary, consent, and audit requirements, within performance and cost targets.
- Design the data foundation for AI features: definitions, provenance, and access controls that let products use clinical and payer data in AI accurately and safely.
Architecture leadership and enablement
- Build reference implementations and shared primitives, and publish the standards and examples teams need to adopt them without waiting on this role.
- Use AI in the engineering work itself (mapping feeds to shared definitions, generating and testing transformations, catching data quality issues) and set the patterns teams follow.
- Review data designs across payer product teams against the shared standards, and work with HNA platform architecture, which owns the overall platform design.
- Work with Product from problem definition, turn product direction into data architecture, and stay with the teams through delivery until the product and platform outcomes land.
- Grow data-modeling skill across engineering teams.
JOB REQUIREMENTS
Education
- Bachelor’s Degree or equivalent technical/business experience (Required)
- Master’s Degree (Preferred)
Work Experience
- 10+ years of relevant work experience; 2–3 years at the Expert level or equivalent experience (Preferred)
- 5+ years of practical experience designing and building enterprise or distributed software systems (Preferred)
- 5+ years designing data platforms for healthcare clinical and/or payer data (claims, eligibility, clinical records) (Required)
Certifications
- AWS Certified Solutions Architect – Professional, or equivalent cloud architecture certification (Preferred)
Knowledge, Skills and Abilities
- Expert in data modeling: relational, dimensional, and FHIR resource modeling, plus canonical models and data contracts.
- Hands-on with healthcare data standards (X12 EDI, NCPDP, HL7 v2, C-CDA, FHIR R4, and the major implementation guides) and code sets (ICD-10, CPT/HCPCS, LOINC, SNOMED CT, RxNorm, NDC).
- API and service design: REST and FHIR APIs, event-driven design, and caching. Writes and reviews production code in a major language such as Python, Java, or C#.
- Working knowledge of the payer business: risk adjustment, quality, care management, utilization management and prior authorization, and CMS interoperability rules.
- Uses AI tools as part of daily design and engineering work.
- Has designed data for AI features on healthcare data: grounding, structured extraction, evaluation, and PHI guardrails.
- Understands how clinical data from provider systems flows into payer use cases such as risk adjustment and quality.
- Designs internal platforms that other teams adopt willingly: clear contracts, sensible defaults, documentation, and migration paths.
- Strong with cloud data platforms and ingestion: AWS, cloud data warehouses or lakehouses (such as Snowflake), relational databases (RDBMS), batch and streaming pipelines, and orchestration.
- Master data management and identity resolution for members and providers.
- Security and compliance for PHI: HIPAA, audit, and the controls behind HITRUST and SOC 2.
- Data quality, observability, and lineage practices.
- Explains data architecture clearly to engineers, product managers, and executives, both in writing and in person.
Travel
- Up to 20% travel may be required
Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.
Enhancing Lives and Building Careers
Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?
Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.
Visa Sponsorship is not offered for this position.
At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.
Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.
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