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Healthcare Subject Matter Expert - Payer

**Category:** Business Analysis (functional and technical)

**Main location:** United States, Massachusetts, Canton

**Position ID:** J1225-1620

**Employment Type:** Full Time

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Position Description:

We are seeking a Healthcare Subject Matter Expert (SME) – Payer who brings deep expertise in payer-domain operations and processes. This individual will play a critical role in evaluating and analyzing current-state workflows across key functions such as claims, provider operations, member services, utilization management, care management, and finance.

Ideal candidate will possess deep healthcare payer knowledge, including a thorough understanding of regulatory requirements, operational workflows, and industry best practices. They will have a proven track record of conducting comprehensive process assessments, validating accuracy and completeness, and delivering actionable insights that support strategic decision-making. This is an opportunity to leverage your domain expertise to influence enterprise-level improvements and shape the future of healthcare operations.

This position is located in our client office in Canton, MA (Hybrid)

Your future duties and responsibilities:

1. Process Discovery & Assessment

• Lead current-state process discovery across payer operations.

• Facilitate working sessions with process owners, SMEs, and analysts

• Document workflows, handoffs, variations, system dependencies, and pain points.

• Identify inefficiencies, risks, compliance gaps, and automation opportunities.

• Ensure alignment with payer regulations (CMS, NCQA, URAC, HIPAA, state mandates).

• Provide domain insights to support transformation initiatives and audits.

2. Process Documentation Support

• Create and validate BPMN process flows (Level 1–5) for current and future states.

• Ensure accurate representation of roles, decisions, systems, compliance checkpoints, and exceptions.

• Review and refine process maps, SIPOCs, and metadata for accuracy and completeness.

3. Process Maturity & Quality Evaluation

• Evaluate processes against payer best practices, benchmarks, and regulatory expectations.

• Assess process maturity and identify gaps (manual steps, fragmentation, non-compliance).

• Conduct current-state vs. future-state gap analyses.

• Develop prioritized, actionable recommendations for process improvement, compliance, and automation.

• Support creation of process improvement roadmaps.

Required qualifications to be successful in this role:

• 7+ years of healthcare payer experience across core operations (claims, enrollment & billing, provider data, UM/CM, appeals & grievances, member and network services).

• 5+ years of experience performing end-to-end process assessment, mapping, and gap analysis.

• Strong understanding of payer regulatory requirements (CMS, state regulations, NCQA, URAC).

• Proven ability to identify operational inefficiencies, risks, and compliance gaps.

• Hands-on experience with BPMN modeling and creation of Level 1–5 process maps.

• Strong analytical and problem-solving skills with attention to detail to define actionable recommendations

• Demonstrated ability to collaborate with process owners, SMEs, analysts, and governance teams.

Desired Skills:

Technology Awareness: Understanding of payer systems (claims platforms, provider portals, care management tools) and emerging technologies like RPA, AI, and interoperability standards.

Continuous Improvement Orientation: Passion for identifying opportunities for automation, digitization, and efficiency gains.

Industry Certifications (Preferred): Lean Six Sigma Green Belt/Black Belt, BPM certifications, or healthcare compliance credentials.

Other Information:

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 $110,800.00 - $194,000.00.

CGI's benefits are offered to eligible professionals on their first day of employment to include:

. Competitive compensation

. Comprehensive insurance options

. Matching contributions through the 401(k) plan and the share purchase plan

. Paid time off for vacation, holidays, and sick time

. Paid parental leave

. Learning opportunities and tuition assistance

. Wellness and Well-being programs

\#LI-MP2

Skills:

+ Business Analysis

+ Business Process Modelling

+ Health Care Payers

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.**

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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.