Lead / Solution Architect Provider Data Management (Facets)

We are seeking an experienced Senior, Lead, or Solution Architect with deep expertise in the TriZetto Facets Provider Module and healthcare provider data management to join our Enterprise Core Administration team in a contract-to-hire capacity. This individual will play a critical role in advancing our provider platform by improving provider data quality, strengthening provider data governance, and leading provider data modernization initiatives across the enterprise. The ideal candidate will possess strong healthcare payer domain knowledge and hands-on experience with provider onboarding, provider maintenance, provider contracting, provider network management, and provider data integration. This individual must be able to analyze provider data discrepancies, identify duplicate provider records, establish enterprise-wide data quality strategies, and ensure accurate provider data synchronization across multiple platforms and lines of business. This is both a hands-on technical role and a strategic leadership opportunity. The successful candidate will work closely with architects, business stakeholders, provider operations teams, and development teams to define the future-state provider data architecture and governance strategy. Primary Responsibilities Develop and maintain provider data integration solutions supporting the TriZetto Facets Provider Module. Design, develop, enhance, and support enterprise provider data solutions. Analyze provider data discrepancies and develop sustainable solutions to improve provider data quality and integrity. Design and implement strategies to identify, prevent, and eliminate duplicate provider records across enterprise systems. Lead provider data governance, stewardship, and master data management initiatives. Analyze provider onboarding, provider maintenance, provider synchronization, credentialing, and provider directory processes. Design scalable integration patterns between Facets and upstream/downstream enterprise systems. Analyze and reconcile provider information from external data sources including: NPPES CMS Provider Files State Medicaid Provider Files Other state, federal, and commercial provider datasets Evaluate provider contracting structures and ensure proper provider setup and maintenance across Medicaid, Medicare, Exchange, and Commercial lines of business. Collaborate with business and operational teams to ensure provider data is configured accurately based on contractual, regulatory, and operational requirements. Design and implement RESTful APIs, web services, and service-based integrations supporting provider data exchange. Participate in modernization initiatives involving API-first architectures, event-driven processing, and cloud-ready integration patterns. Troubleshoot complex provider data and integration issues and identify long-term corrective actions. Participate in architecture reviews and contribute to provider data modernization roadmaps. Provide technical leadership, mentoring, and best-practice guidance to development and data teams.

5+ years of experience with the TriZetto Facets Provider Module Deep understanding of healthcare payer provider operations and provider lifecycle management. Strong understanding of provider contracting and provider setup requirements across Medicaid, Medicare, Exchange (Marketplace) and Commercial Health Plans Ability to analyze differences in provider configuration, contracting, reimbursement methodologies, network participation, specialties, and affiliations across multiple lines of business. Strong experience analyzing provider data quality issues, provider record discrepancies, and duplicate provider management strategies. Hands-on experience working with external provider data sources, including: NPPES CMS Provider Files State Medicaid Provider Files Credentialing Data Sources Provider Directory Data Sources Strong understanding of Facets Provider integration capabilities, including: XPF Batch Processing Provider Web Services Provider Data Synchronization Mechanisms Inbound and Outbound Provider Integrations Real-time and Batch-Based Integration Patterns Proven experience implementing provider data integrations using standard Facets product capabilities and industry best practices. Strong knowledge of Facets Extension capabilities related to the Provider Module, including provider maintenance workflows, validation frameworks, custom provider processing, and provider batch extensions. Ability to evaluate and recommend appropriate integration approaches using XPF batches and Web services Strong Microsoft SQL Server development experience including: Complex SQL Queries Stored Procedures Data Reconciliation Data Profiling Performance Optimization Experience with enterprise integration architectures and service-oriented design. Excellent analytical, problem-solving, and communication skills. Preferred Qualifications Experience implementing Provider Data Management solutions. Experience establishing provider data governance frameworks and operating models. Hands-on experience developing or supporting Facets Provider Extensions. Experience modernizing legacy provider integrations by transitioning batch-based processes to API-driven and event-driven architectures. Experience with Kafka, SSIS, Azure DevOps, Git, and CI/CD Pipelines Strong understanding of healthcare interoperability standards. Experience mapping and transforming TriZetto Facets Provider data structures to HL7 FHIR resources Understanding of provider directory modernization and interoperability initiatives. Experience leveraging AI-assisted development tools such as GitHub Copilot, Claude Code, or similar platforms. Previous experience supporting large enterprise healthcare organizations is highly desirable. Leadership Expectations, We are looking for someone who combines deep Facets Provider Module expertise with strong healthcare provider domain knowledge and architectural leadership. The ideal candidate understands not only how provider data is configured in Facets, but also how provider contracting, network participation, credentialing, provider hierarchies, affiliations, and line-of-business differences impact provider data management.

Depending on experience, this individual may: Lead provider data architecture and solution design initiatives. Establish provider data governance standards and best practices. Drive enterprise data quality and deduplication strategies. Mentor developers, analysts, and architects. Partner with enterprise architecture teams on modernization initiatives. Influence long-term provider data management strategy and roadmap development.