Business System Analyst - Interoperability

Category: Business Analysis (functional and technical)

Main location: United States, Massachusetts, Canton

Position ID:J0626-0331

Employment Type: Full Time

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