Payer Engineer

This role is for one of Weekday’s clients
Min Experience: 22 years
JobType: full-time

We are looking for a seasoned and highly experienced Payer Engineer with deep domain expertise in US Healthcare systems and a proven track record of leading product engineering initiatives in complex healthcare environments. This role requires a strategic thinker with a hands-on approach to solving real-world healthcare payer challenges through innovative technology solutions.

You will work closely with cross-functional teams, including product managers, enterprise architects, payers, claims processors, and engineering leaders to design, build, and enhance scalable, compliant, and interoperable systems that serve the evolving needs of health insurance companies and healthcare providers.

Key Responsibilities:

• Lead product engineering efforts across healthcare payer platforms, including claims management, eligibility verification, benefits administration, and payment systems.
• Collaborate with product and engineering teams to define architecture and roadmap aligned with US healthcare regulations and payer needs.
• Drive development and deployment of new features and solutions within payer ecosystems (including Medicare, Medicaid, and Commercial Insurance).
• Ensure robust integration with third-party systems including clearinghouses, EHRs/EMRs, and government databases (e.g., CMS, HIPAA).
• Provide domain expertise in healthcare claims lifecycle, adjudication processes, risk scoring, and utilization management.
• Translate business requirements into scalable technical solutions with high attention to compliance, security, and data integrity.
• Oversee migration of legacy systems to modern platforms leveraging cloud infrastructure (e.g., AWS, Azure, GCP).
• Mentor and guide engineering teams to adopt best practices in software development, agile methodology, and DevOps.
• Evaluate vendor solutions, APIs, and open standards (HL7, FHIR, X12) for interoperability and integration potential.
• Stay current with emerging regulatory requirements (e.g., Interoperability Rule, No Surprises Act) and recommend proactive product enhancements.

Required Skills & Qualifications:

• 22+ years of progressive experience in software engineering, with at least 10 years in the US healthcare payer domain.
• In-depth understanding of payer business models, operations, and pain points.
• Strong command over healthcare EDI formats (especially X12), claim workflows (837, 835), and eligibility (270/271).
• Experience leading development of healthcare payer products or core admin systems (Facets, QNXT, HealthRules, etc.).
• Solid experience with data engineering, rules engines, and analytics as applied to healthcare cost optimization and quality measures.
• Technical proficiency in modern programming languages and frameworks (Java, Python, .NET), cloud platforms, and microservices architecture.
• Demonstrated ability to manage large-scale digital transformation programs in healthcare.
• Strong stakeholder communication and leadership skills, with a proven ability to operate cross-functionally.
• Bachelor's/Master’s in Computer Science, Engineering, Health Informatics, or related field.

Preferred Qualifications:

• Experience with value-based care models and population health analytics.
• Familiarity with FHIR APIs, CMS Blue Button 2.0, and real-time data exchange standards.
• Certification in healthcare IT systems or compliance (e.g., CPHIMS, PMP, HL7 Certified).
• Experience working with HealthTech startups or scaling enterprise solutions in payer space.