Healthcare Subject Matter Expert Payer

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 15) 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 15 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 $110800.00 - $194000.00.

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:

• Business Analysis
• Business Process Modelling
• Health Care Payers

What you can expect from us:

Together as owners lets turn meaningful insights into action.

Life at CGI is rooted in ownership teamwork respect and belonging. Here youll 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. 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.

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 . 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 CGIs legal duty to furnish information.