Full-Time

Lead Enterprise Process Architect

Healthfirst

Healthfirst

1,001-5,000 employees

Non-profit insurer offering MLTC, Medicare Advantage.

Compensation Overview

$143.4k - $267.2k/yr

+ Incentive and recognition programs

Company Does Not Provide H1B Sponsorship

Lake Mary, FL, USA + 1 more

More locations: New York, NY, USA

Hybrid

Three days in office per week, Tuesday through Thursday, in New York City or Lake Mary.

Bachelor's, Master's

Category
Business & Strategy (1)
Required Skills
Product Management
Risk Management
Financial Modeling

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Requirements
  • A master's or bachelor's degree in business, computer science, engineering, systems analysis, operations management, or a related field, or equivalent experience.
  • A high school diploma or General Educational Development credential from an accredited institution.
  • At least eight years of experience in process architecture, enterprise architecture, operating model design, business transformation, solution architecture, or related disciplines.
  • Deep expertise in process decomposition methodologies, Business Process Model and Notation, value stream mapping, process modeling, process governance, workflow design, and process lifecycle management.
  • Experience designing operating models that integrate human workers, automation technologies, enterprise systems, and artificial intelligence-enabled capabilities.
  • Demonstrated experience leading enterprise-wide process transformation, modernization, or workflow standardization initiatives.
  • Working knowledge of artificial intelligence-enabled workflow design, agentic process patterns, human-in-the-loop models, human-on-the-loop models, and responsible artificial intelligence governance considerations.
  • Ability to partner with enterprise delivery programs to translate business capabilities and operating needs into process architectures, workflow patterns, and executable process designs.
Responsibilities
  • Establish and govern enterprise process architecture standards, including process taxonomy, decomposition methods, workflow design patterns, documentation expectations, and governance practices.
  • Define common methods for decomposing business capabilities into processes, subprocesses, decisions, tasks, system interactions, agent responsibilities, escalation paths, and control points.
  • Create and maintain process reference architecture, reusable process modules, workflow components, decision services, automation services, and agent-enabled business services.
  • Partner with enterprise delivery programs to apply consistent process architecture practices across initiatives and align process designs to enterprise standards.
  • Define human-agent workflow patterns that clarify how work is performed across people, artificial intelligence agents, automation platforms, and enterprise systems.
  • Define standards for incorporating artificial intelligence agents into business processes, including accountability, decision rights, workflow boundaries, permissions, auditability, orchestration, and agent-to-agent interaction.
  • Identify opportunities to redesign business processes around artificial intelligence and agent capabilities rather than simply automating existing workflows.
  • Recommend process modernization opportunities using business process management, process mining, task mining, workflow analytics, and process intelligence methods.
  • Establish process performance baselines and measurable outcomes for artificial intelligence-enabled transformation, including cycle time, manual effort reduction, control effectiveness, and business value realization.
  • Ensure artificial intelligence-enabled processes maintain alignment with regulatory, privacy, security, audit, responsible artificial intelligence, and operational risk requirements.
  • Advise leadership and enterprise delivery programs on operating model evolution as artificial intelligence agents increasingly participate in business execution.
  • Coach architects, product owners, delivery teams, and business partners on process architecture, process decomposition, agentic process design, and human-agent workflow patterns.
Desired Qualifications
  • Experience defining human-agent interaction models, artificial intelligence-enabled operating models, and workflow patterns that coordinate people, agents, automation, and systems.
  • Experience with process mining or process intelligence platforms such as Celonis, Signavio, SAP Process Intelligence, UiPath Process Mining, or similar technologies.
  • Familiarity with workflow orchestration platforms, case management platforms, rules engines, agentic workflow frameworks, and enterprise automation technologies.
  • Understanding of organizational design, operating model transformation, digital workforce strategies, and change impacts associated with artificial intelligence-enabled process redesign.
  • Experience establishing enterprise process architecture practices, standards, reference models, governance routines, and reusable process design assets.
  • Exposure to governance and compliance disciplines, including privacy, security, audit, risk management, and responsible artificial intelligence practices.
  • Understanding of product management, agile methodologies, and development practices, with the ability to guide delivery teams on architectural impacts, implementation risks, and technical debt.
  • Experience evaluating opportunities for agent-enabled process transformation, including task allocation, exception handling, escalation models, observability, and control design.
  • Experience designing process key performance indicators and evaluation frameworks to measure process performance, agent contribution, human-agent interaction quality, and business value realization.
  • Comprehensive understanding of health insurance business models, healthcare operations, financial modeling, cost-benefit analysis, and risk management.
  • Intellectual curiosity, integrity, systems thinking, and a commitment to responsible artificial intelligence and human-centered process design.

Healthfirst is a New York-based nonprofit health insurer offering MLTC, Medicare Advantage, and the Essential Plan to serve different needs. MLTC coordinates ongoing in-home and community-based care through a network of providers; Medicare Advantage combines Medicare with extra benefits; Essential Plan provides affordable coverage for income-qualified residents. It differentiates itself through nonprofit status, a strong local focus in the New York metro area, and active community outreach and provider partnerships. Its goal is to improve access to affordable, comprehensive health coverage for New Yorkers, especially vulnerable groups, by leveraging its mission and local network.

Company Size

1,001-5,000

Company Stage

N/A

Total Funding

N/A

Headquarters

New York City, New York

Founded

1993

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Simplify Jobs

Simplify's Take

What believers are saying

  • Healthfirst updated Medicare Advantage benefits on August 4, 2026, emphasizing $0 premiums.
  • July 23, 2026 D-SNP rules preserve coverage paths for Medicaid-eligible members.
  • Mobile crisis services lost cost sharing January 1, 2026, strengthening Essential Plan value.

What critics are saying

  • EP 200-250 ends July 1, 2026, forcing members into pricier alternatives.
  • Greene v. Healthfirst PHSP alleges ghost-network directories; trial pressure builds through 2026.
  • Cotiviti claim reviews and new prior authorizations on August 1, 2026 anger providers.

What makes Healthfirst unique

  • Largest Medicare Advantage membership in New York anchors Healthfirst’s local scale.
  • $0 Essential Plan pricing and broad Medicaid coordination fit New York’s subsidy market.
  • 2026 D-SNP, MLTC, and provider portal changes deepen its managed-care integration.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

401(k) Company Match

Performance Bonus

Company News

Queens Courier
Oct 29th, 2025
Nonprofit recognizes Queens pharmacies for improving health of members with Medicare

Nonprofit recognizes Queens pharmacies for improving health of members with Medicare. Edgar Gutierrez, left, and his wife Mireya Gutierrez, owners and pharmacists of Victory Pharmacy in Queens, were recognized for their work improving community health for members on Medicare. Three pharmacies in Queens were recognized by Healthfirst, a nonprofit health insurer serving more than two million New Yorkers, for their work to improve the health of members covered under the nonprofit's Medicare plan. Winners of the nonprofit's inaugural Pharmacy Excellence Awards, which were presented to 12 community pharmacies across the city, were announced by Healthfirst Oct. 14. The Queens winners include All RX Pharmacy 1 and Arcadia Health Pharmacy, both located in Flushing, and Victory Pharmacy in Jackson Heights. Recipients of the awards, who were among hundreds of participating community pharmacies, were honored for achieving the city's highest rates of medication adherence and proactive pharmacy interventions to close gaps in care in 2024. The awards align with the mission of the Healthfirst program, which is aimed at equipping community and independent pharmacists with new tools and technology to help close care gaps, improve medication adherence and provide timely support for members on Medicare. According to the nonprofit, the winning pharmacies across Queens, the Bronx, Brooklyn and Manhattan are trusted healthcare partners in their neighborhoods. Together, they have helped thousands of older adults better manage chronic conditions, avoid hospitalizations and stay on track with vital prescriptions. Get the full story. News, events, culture and more - delivered to you. "Community pharmacies know their patients by name and understand the challenges they face every day, and that they want more time to educate patients with medication management but also have the demands of running a small business," said Bhavesh Modi, vice president of pharmacy at Healthfirst. "Through this program, we're giving pharmacists the tools and resources they need to make an even greater impact on the health of their communities." Medication adherence is one of the most important factors in improving long-term health outcomes for Medicare members, according to the nonprofit. Pharmacies enrolled in the program have helped significantly boost adherence rates, ensuring more Medicare members are taking their medications as prescribed. "It can be daunting to manage several medications without support, especially for our seniors," said Bronx state Sen. Gustavo Rivera, who chairs the Senate Health Committee. "I extend my congratulations to the local pharmacies being honored and commend Healthfirst for recognizing the role that independent pharmacies play in helping New Yorkers lead healthier lives." Edgar and Mireya Gutierrez, who are owners and pharmacists of Victory Pharmacy and recipients of this year's award for their work, said their partnership with Healthfirst has helped the couple better serve their patients. "As pharmacists, we believe we are often the first point of contact for care in our neighborhoods," the couple said in a joint statement. "Working with Healthfirst gives us new ways to strengthen that connection - whether it's checking in on a member's medication or helping them understand their benefits. It's collaboration that makes a real difference." The announcement was made during American Pharmacists Month, observed annually in October, just ahead of Medicare open enrollment, which began Oct. 15 and ends on Dec. 7. The nonprofit said the awards underscore the critical role pharmacists play in educating older New Yorkers about their healthcare decisions. By honoring community pharmacies with the Pharmacy Excellence Awards, Healthfirst is reinforcing its commitment to empowering local providers to deliver personalized, high-quality care. Healthfirst was founded in 1993 by leading hospital systems in downstate New York. Its partnership model drives collaboration across the hospitals, health systems and community providers in its network, which is aimed at advancing care quality and improving health outcomes for its members. The nonprofit currently serves more than two million members in New York City, on Long Island, and in Westchester, Rockland, Sullivan and Orange counties. Healthfirst offers plans for members of all ages including Medicaid, Medicare Advantage, Child Health Plus, Essential Plan, Long-Term Care and Qualified Health plans. For more information on Healthfirst, please visit Healthfirst.org.

New Castle News
Aug 21st, 2025
Healthfirst Ranked #1 in Quality Among New York State Medicaid Plans

Healthfirst, a leading not-for-profit health plan serving more than two million New Yorkers, has been recognized as the top-performing Medicaid Managed Care plan in New York State's Department of Health Medicaid Quality Incentive Program results for 2023, which were released in August 2025.

Business Wire
May 15th, 2024
Hyphen, Healthfirst Collaboration To Empower Pharmacists’ Role In Value-Based Care Receives 2024 Points Of Light Award From Klas Research

HARTFORD, Conn.--(BUSINESS WIRE)--Hyphen, the technology company creating connected-care, has received a 2024 Points of Light Award from KLAS Research, the leading healthcare research and insights firm, for its efforts to improve payer-provider collaboration in support of improved outcomes in value-based care with Healthfirst, a non-profit health plan serving close to 2 million New Yorkers. KLAS recognized Hyphen’s Pharmacy Assistant application, which supports Healthfirst’s Pharmacy Incentive Program. The program is designed to empower community pharmacists within Healthfirst’s network to take action to improve medication adherence rates, increase members’ understanding of their health plan benefits, and get compensated for those actions. This program is especially impactful because 80% of Medicare Advantage members in New York visit their community pharmacy 5-10 times annually — more than they visit their primary care doctor. The Pharmacy Assistant application connects disparate data sources and delivers real-time, actionable information in pharmacists’ existing workflows so they can close care gaps

MENAFN
Jan 25th, 2024
Montefiore Designated As A Behavioral Center Of Excellence, Granted $7M To Address Gaps In NYC Mental And Behavioral Health Care

New York State Office of Mental Health Funding to Support Plans for New Comprehensive Psychiatric Emergency Program and Outpatient Services Includin

The News Journal
Sep 20th, 2023
Health First announces local grants

HealthFirst partnered with the Clinton County Foundation to ensure grant funding is annually available to the community.