Business System Analyst - Interoperability

Business System Analyst - Interoperability

Category: Business Analysis (functional and technical)

Main location: United States, Massachusetts, Canton

Position ID: J0626-0331

Employment Type: Full Time

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Position Description:

The Interoperability Business Systems Analyst is a strategic and hands-on implementation partner within a healthcare payer organization, responsible for driving the end-to-end evaluation, onboarding, and operational integration of digital health vendor solutions. This role owns the business and technical requirements lifecycle for a growing portfolio of point solutions across musculoskeletal health, behavioral health, chronic disease management, remote patient monitoring, and wellness - spanning vendors such as Hinge Health, Omada, Livongo, Sword Health, Calm, Teladoc, Brightline, and others.

The BSA bridges strategy and execution: translating clinical program goals and payer operations requirements into technical specifications, data exchange designs, and vendor accountability frameworks. This individual will work closely with clinical, network, IT, product, compliance, and vendor teams to ensure that each digital health solution is implemented on time, within scope, and delivers measurable member and business outcomes.

This role must be performed from the client site in Canton, MA - Hybrid

Your future duties and responsibilities:

Interoperability Implementation & Requirements Analysis

. Gather, document, and validate business and technical requirements for interoperability solutions such as FHIR APIs, Member Access APIs, Provider Directory APIs, Payer-to-Payer Data Exchange, and Prior Authorization APIs.

. Analyze CMS/ONC regulations (e.g., CMS Interoperability & Patient Access Rule, CMS Prior Authorization Rule, TEFCA-related requirements) and translate them into actionable system requirements.

. Support gap analysis for existing payer systems (claims, clinical data, provider, member, authorization) to determine interoperability readiness.

Solution Design & Functional Specifications

. Develop functional specifications, user stories, acceptance criteria, and process workflows for interoperability implementations.

. Work with architects and engineers to define data mapping, transformation logic, and API interaction models aligned with HL7 FHIR standards.

. Ensure solutions integrate effectively with enterprise systems such as claims adjudication, enrollment, provider management, UM/PA, care management, and data warehouses.

Data Analysis & Quality Assurance

. Perform data profiling and mapping for clinical and administrative datasets (e.g., EDI 837/835, 270/271, CCDA, FHIR resources).

. Support test case development, test planning, and execution for API validation, edge-case handling, and compliance testing.

. Ensure data accuracy, completeness, and compliance with security and privacy standards (HIPAA, PHI/PII handling).

Stakeholder Engagement & Project Support

. Serve as the liaison between business stakeholders and technical teams, ensuring alignment on requirements, scope, and delivery timelines.

. Participate in sprint planning, backlog grooming, and solution demonstrations as part of Agile/Scrum teams.

. Provide subject matter expertise (SME) on payer workflows such as claims processing, member onboarding, provider data management, care management, and prior authorizations.

Required qualifications to be successful in this role:

. 7-10 years of experience as a Business Analyst or Business Systems Analyst in the healthcare payer domain.

. Strong understanding of FHIR standards, HL7, EDI transactions, and healthcare information exchange models.

. Hands-on experience with interoperability implementations, preferably CMS-mandated FHIR APIs or payer modernization initiatives.

. Working knowledge of healthcare payer systems and processes (benefits, claims, enrollment, provider data, UM/PA).

. Experience writing business, functional and technical specs, data mapping documents, and business process flows.

. Strong analytical, problem-solving, and communication skills.

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 $80,600.00 - $172,400.00.

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

• Functional Analysis

• Health Care Analytics

• Health Care Payers

• Oracle

• SQL

What you can expect from us:

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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.

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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.