Description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Requisition Job Description

About the Role

We're seeking a Principal Engineer with deep expertise in Java full stack development, Google Cloud Platform (GCP), and Generative AI, with a strong background in healthcare payer applications. You will lead architecture and delivery of high-scale platforms across Medicare, Medicaid, and Commercial lines of business-spanning claims, eligibility, provider, utilization management, and compliance initiatives.

Domain Focus: Healthcare Payer (Medicare, Medicaid, Commercial)

You'll build and modernize platforms that support:

• Medicare / Medicare Advantage (MA & Part D):
• STARS, HEDIS/QM measures, Risk Adjustment (HCC), Encounter data, CTM/Grievances & Appeals
• CMS interoperability (Patient Access & Payer-to-Payer APIs), Prior Authorization modernization
• Medicaid (State Programs):
• Eligibility & enrollment (834), capitation & encounters, Waiver programs, state reporting
• Care management, utilization management (UM), SDoH integrations, EVV and PA automation
• Commercial (Fully-Insured & ASO):
• Benefits & accumulators, COB, authorizations, claims adjudication workflows
• Provider directory accuracy, price transparency, digital member & provider experiences

Key Responsibilities

• Architecture & Delivery
• Lead end-to-end architecture for cloud-native applications using Java/Spring Boot, React/Angular, microservices, and event-driven patterns.
• Design FHIR R4-based APIs and payer interoperability solutions; integrate with EDI services for X12 transactions.
• Build scalable data pipelines on GCP (e.g., Pub/Sub, Dataflow, BigQuery, Cloud Run, GKE, Cloud Functions) with appropriate IAM and VPC security.
• GenAI Solutions
• Apply Vertex AI and LLMs for use cases like prior authorization summarization, member/provider 360 assistants, claims triage, contact center AI, and document intelligence (OCR → structured data).
• Establish prompt engineering patterns, governance, evaluation frameworks, guardrails, and PHI-safe architectures.
• Compliance & Security
• Ensure adherence to HIPAA, PHI handling, HITRUST/SOC 2 controls; support CMS regulatory mandates (e.g., Interoperability Rule).
• Champion privacy-by-design, data minimization, and secure SDLC practices.
• Leadership & Collaboration
• Mentor engineers, drive code/design reviews, set engineering standards (testing, SRE, CI/CD).
• Partner with Product, Enterprise Architecture, Compliance, and Clinical/Operations stakeholders to align on roadmap and outcomes.

Example Initiatives (by Business Line)

• Medicare
• Build Payer Interoperability APIs (Patient Access, Provider Directory, Payer-to-Payer) using FHIR R4 on GCP with Apigee; persist to BigQuery; enable consent & audit trails.
• Risk Adjustment ingestion and HCC scoring pipeline (X12 837/835, encounter data) with quality dashboards and Star Ratings observability.
• Medicaid
• Eligibility (834) and capitation services; integrate 278 Prior Auth with AI-driven clinical summarization to reduce turnaround time.
• State-specific encounter reporting and error remediation workflows with rules-as-code and validations.
• Commercial
• Claims microservices (adjudication orchestration, pricing & accumulators) with Kafka-style eventing and idempotent processing.
• Provider Directory accuracy using GenAI for record matching/normalization; price transparency APIs and self-service member experiences.

Required Qualifications

• 10+ years in software engineering; 5+ years leading architecture for large-scale platforms.
• Advanced Java, Spring Boot, REST/gRPC, microservices, and front-end (React/Angular, TypeScript).
• GCP expertise: BigQuery, Pub/Sub, Dataflow/Beam, Cloud Run/GKE, Cloud Storage, Secrets Manager, Cloud IAM, Cloud Build, Apigee.
• GenAI/ML exposure: Vertex AI, LLMs, prompt design, retrieval augmentation, evaluation/guardrails.
• Healthcare Payer experience with EDI X12 (e.g., 270/271, 276/277, 278, 834, 835, 837, 820), FHIR R4, and payer workflows (claims, eligibility, UM/PA, provider, member).
• Strong knowledge of HIPAA, PHI, RBAC/ABAC, data encryption, and auditability.
• Proven leadership: technical strategy, mentoring, cross-functional alignment, executive communication.

Preferred Qualifications

• Experience with Medicare Advantage (STARS/HEDIS, risk adjustment, encounter submissions) and Medicaid (state reporting, waivers).
• MLOps and data engineering (e.g., feature stores, model monitoring, lineage/metadata).
• Event streaming (Kafka/Pub/Sub), CQRS, saga patterns; domain-driven design.
• API management (Apigee), OpenAPI/Smart on FHIR, and payer identity models (member/provider/NPI).
• Security certifications or hands-on with HITRUST, SOC 2, ISO 27001.

Tech Stack

• Backend: Java 17+, Spring Boot, REST/gRPC, JPA, Redis
• Frontend: React or Angular, TypeScript, RxJS, Material/Prime
• Data/Events: BigQuery, Dataflow/Beam, Pub/Sub, (Kafka optional), Cloud SQL/Spanner
• AI/ML: Vertex AI (Search, RAG, fine-tuning), Document AI, Contact Center AI
• DevOps/SRE: Docker, GKE/Cloud Run, Terraform, Cloud Build/Argo, GitHub Actions, OpenTelemetry, Cloud Monitoring/Logging
• APIs/Standards: FHIR R4, HL7 v2 (as needed), EDI X12 (270/271, 276/277, 278, 834, 835, 837, 820), SMART on FHIR

Education

Bachelor's degree required. Master's degree preferred

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$101,970.00 - $203,940.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/27/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.