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Healthcare Edits Intelligence Engineer

**Category:** Analytics and Emerging Digital Technologies

**Main location:** United States, Virginia, Fairfax

**Position ID:** J0525-2224

**Employment Type:** Full Time

Position Description:

CGI is seeking a highly motivated, self-driven, and creative Healthcare Edits Intelligence Engineer to support our Payment Integrity and Healthcare Analytics teams. This role will leverage advanced data analysis and data science techniques to identify patterns, trends, and anomalies in healthcare claims, with a focus on optimizing payment accuracy, detecting improper payments, identifying potential fraud, and enhancing overall revenue cycle management.

This is a full-time hybrid position, requiring on-site presence at your nearest CGI office two to three days per week.

Your future duties and responsibilities:

• Understand Healthcare Claims Auditing principles and ideate new EDITs to new saving while auditing healthcare clams.

• Collaborate with clinicians, coding specialists, and other stakeholders to analyze healthcare claims for accuracy, coding compliance, and adherence to insurance policies.

• Apply data mining techniques to analyze large datasets of healthcare claims to identify trends, patterns, and anomalies related to utilization, pricing, and billing practices.

• Develop, deploy, & optimize predictive models to identify high-risk claims, improper payments, and potential fraud, driving cost reduction and improved accuracy.

• Design, implement, and monitor AI/ML models that analyze medical claims to detect improper payments, anomalies, and fraud.

• Generate comprehensive reports and dashboards that visualize key performance indicators (KPIs) related to claims editing, payment integrity, revenue cycle management, and other actionable healthcare insights.

• Communicate data-driven insights to management, claim auditors, edit specialists, and other stakeholders, facilitating informed decision-making and the implementation of corrective actions.

• Develop Data Pipelines, Build Tableau Reports, Support Ad-Hoc data request on a Production Support environment.

• Ensure compliance with CGI policies and procedures, HIPAA privacy regulations, data security protocols, and relevant industry standards and laws.

• CGI reserves the right to assign new tasks or duties to this role as needed.

Required qualifications to be successful in this role:

• Education: Bachelor’s degree with 5 years of experience, or a master’s degree in computer science, Mathematics, Statistics or Data Science.

• Claims Editing: Proficiency in using claims editing solutions and understanding healthcare billing practices.

• Clinical Knowledge: Familiarity with medical terminology and coding systems such as ICD-10, CPT, and HCPCS.

• Data Science Expertise: Strong background in statistical analysis, machine learning algorithms, and data visualization. Proficiency with programming languages such as Python, R, SAS, SQL, and experience with Tableau or PowerBI.

• Data Engineering: Solid hands-on experience with data processing tools such as Databricks.

• Analytical Skills: Strong ability to identify patterns, analyze complex data, and draw actionable insights.

• Problem-Solving: Excellent skills in identifying root causes and developing effective solutions.

• Communication: Ability to clearly communicate technical insights to both technical and non-technical audiences.

• Knowledge of AI/ML Development Lifecycle

Desired Skills:

• Experience working in the healthcare industry or with healthcare-related data.

• Understanding of payment integrity workflows and the revenue cycle process.

CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to skill set, level, experience, relevant training, and licensure and certifications. To support the ability to reward for merit-based performance, CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range for this role in the U.S. is $88,200.00 - $195,200.00.

At CGI we call our professionals CGI Partners to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:

• Competitive compensation including profit participation program

• Comprehensive medical, dental, and vision benefits

• Basic life and accidental death & dismemberment insurance

• Matching contributions through 401(k) plan, and CGI share purchase plan

• Flexibility and paid accrued vacation leave, ranging from 10 to 20 days per year, based on job level, years of relevant prior experience, and years of service

• 8 paid holidays per year

• Learning opportunities and tuition assistance

• Wellness and Well-being programs

For more detailed information about our benefits offerings, visit Benefits | CGI Careers

Please note that the benefits listed above are subject to change based on the specific terms and conditions of the contract being supported.

\#LI-KB5

Skills:

+ Data Engineering

What you can expect from us:

Together, as owners, let’s turn meaningful insights into action.

Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you’ll reach your full potential because…

You are invited to be an owner from day 1 as we work together to bring our Dream to life. That’s why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company’s strategy and direction.

Your work creates value. You’ll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.

You’ll shape your career by joining a company built to grow and last. You’ll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.

Come join our team—one of the largest IT and business consulting services firms in the world.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status or responsibilities, reproductive health decisions, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics to the extent required by applicable federal, state, and/or local laws where we do business.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at [email protected] . You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. **Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.**

We make it easy to translate military experience and skills! Clickhere (https://cgi-veterans.jobs/) to be directed to our site that is dedicated to veterans and transitioning service members.

All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.