HRP Migration Architect

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Position Description:

CGI is seeking a Lead Architect to drive the modernization of a healthcare payers core claims platform through migration from a legacy claims engine to HealthEdge HealthRules Payer (HRP). In this high-impact role you will define the target-state architecture lead the migration strategy and design critical integrations from initial discovery through implementation cutover and post-production stabilization.


This position to be performed near Burlington MA- Hybrid

Your future duties and responsibilities:

. Target state architecture: Define the HRP solution architecture across Member Product/Benefit Provider Claims and Financial modules and keep it aligned with the enterprise architecture.
. Migration strategy: Design the end to end approach including data migration (extract transform load reconcile) cutover options (big bang vs. phased/LOB wise) parallel runs and rollback.
. Legacy to HRP mapping: Lead gap/fit analysis and data mapping from legacy structures to HRPs data model. Resolve configuration vs. customization decisions.
. Configuration oversight: Guide benefit plan product pricing/fee schedule contract accumulator and adjudication rule configuration in HRP.
. Integration and EDI design: Own the integration landscape around HRP: X12 transactions: 837 (P/I/D)/271 276/277 278 Clearinghouse enrollment eligibility and billing flows Downstream feeds: finance/GL pharmacy (PBM) UM/care management data warehouse reporting APIs and event/messaging patterns plus interoperability touchpoints (e.g. CMS 0057 API dependencies)
. Data quality and reconciliation: Define migration validation financial and claims reconciliation and open claim/in flight transition rules.
. Testing and readiness: Shape the QE strategy (system integration end to end UAT regression performance). Define entry/exit criteria and go live readiness.
. Governance and leadership: Act as technical authority with the client HRP vendor and delivery teams. Own design decisions risk/issue management and architecture review boards.
. Stakeholder communication: Translate technical decisions for business operations and executive audiences.

Required qualifications to be successful in this role:

. 10 years in healthcare payer technology with 5 years of hands on HRP experience
. Led at least 1-2 full core claims migrations to HRP (not just implementation or support)
. Deep functional and technical knowledge of HRP modules: Member Product Provider Claims Financials
. Strong command of HIPAA X12 EDI and how it maps to HRP inbound/outbound processing
. Proven data migration experience at payer scale (conversion design mapping reconciliation mock loads)
. Solid understanding of claims adjudication pricing accumulators COB appeals and payment/remit processes
. Experience with integration patterns (APIs MQ/ESB ETL batch vs. real time)
. Familiarity with regulatory requirements (HIPAA CMS state mandates)
. Strong executive level communication and client facing leadership


Preferred qualifications


. HealthEdge certifications or direct HealthEdge partner/vendor experience
. Experience with multiple LOBs (Commercial Medicare Advantage Medicaid Exchange)
. Exposure to cloud hosted HRP deployments and DevOps/CI CD for configuration promotion
. Experience applying AI/automation to migration testing mapping or reconciliation
. Background in payer mergers or multi entity platform consolidations


Education: Bachelors degree in computer science or similar field.


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 $98500.00 $172400.00.

CGIs 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:

• Application Integrator-EDI
• Data Migration
• Health Care Payers
• Solutions Architecture

What you can expect from us:

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

Your work creates value. Youll 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.

Youll shape your career by joining a company built to grow and last. Youll 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 teamone of the largest IT and business consulting services firms in the world.

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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 CGIs legal duty to furnish information.

Required Experience:

Staff IC