Solution Architect in Healthcare - Dallas, TX | TCS Job

The Delivery Lead is responsible for leading large-scale U.S. healthcare payer contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility. This role owns end-to-end delivery excellence including SLAs, regulatory compliance, financial performance, workforce productivity, and transformation initiatives across Commercial, Medicare, and Medicaid lines of business. The role serves as a senior client-facing leader managing complex multi-LOB healthcare operations while driving cost optimization, quality, and AI-led transformation.

Responsibilities and Duties: 

•Provide hands on leadership for 200 - 400+ FTE U.S. healthcare contact center operations across Member Services, Provider Services, Claims, Enrollment, and Eligibility

•Act as a U.S. payer domain SME with deep understanding of member and provider journeys

•Own end to end KPIs and SLAs including AHT, ASA, FCR, quality, accuracy, grievance TAT, and appeals resolution

•Ensure compliance with U.S. healthcare regulations including HIPAA, CMS, Medicare, Medicaid, ACA, and state mandates

•Lead governance with U.S. payer leadership across Operations, CX, Compliance, and Medical Management

•Drive cost to serve reduction through workforce optimization, automation, and AI led interventions

•Lead U.S. healthcare transformation initiatives including digital self service, contact reduction, intelligent routing, and agent assist

•Proactively identify and mitigate operational, regulatory, and compliance risks

•Support U.S. healthcare pursuits and expansions with SME ownership for solutioning, pricing, and operating model design

•Own delivery financials including budgeting, productivity targets, and P&L performance

•Build leadership capability across Managers and Senior Managers and drive a high performance delivery culture

Qualifications: 

•Bachelor’s or Master’s degree in Business Administration or related discipline

•13+ years BPO and contact center delivery operations

•10+ years in U.S. healthcare contact center leadership roles

•Mandatory experience in U.S. Member Services across Commercial, Medicare, or Medicaid

•Strong exposure to Provider Services and payer back-office integration

•Hands-on experience with payer platforms such as Facets, QNXT, WGS, PEGA, and portals

•Strong knowledge of CMS audits, HEDIS, STAR ratings, and G&A processes

•Lean Six Sigma Green or Black Belt Certification preferred

Salary Range: $138,600 - $187,500 a year

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