Senior Business Analyst - EDI

CGI is hiring a Senior Business Analyst - EDI to analyze, document, and validate requirements for healthcare claims processing systems. The role focuses on EDI transaction flows, claims data analysis, API validation, production defect resolution, and coordination between business and technical teams.

Responsibilities:

• Analyze, document, and validate business requirements for healthcare claims processing systems, focusing on EDI transactions (837, 835, 276/277, 271/270, etc.)
• Review and interpret claim gateway (GW), HIPAA compliance rules, and claim edits to ensure accurate processing and regulatory adherence
• Develop and maintain detailed design and mapping documents for EDI transaction flows and system integrations
• Write, analyze, and optimize complex SQL queries against Teradata to support data analysis, validation, and reporting needs
• Support and execute testing/validation of REST APIs used in claims and data exchange processes
• Investigate, triage, and drive resolution of production defects, coordinating root cause analysis with technical teams
• Serve as a liaison between business stakeholders, IT development teams, and production support to ensure requirements are accurately translated into technical solutions
• Support Availity enablement activities and Medicare related claims processing workflows, where applicable
• Participate in requirement walkthroughs, design reviews, and UAT to ensure solution quality and business alignment
• Communicate status, risks, and issues clearly to both technical and non technical stakeholders

Requirements:

• Strong understanding of U.S. healthcare with good understanding of the claims lifecycle
• Hands on experience with EDI healthcare transactions: 837 (claims), 835 (remittance), 276/277 (claim status), 271/270 (eligibility)
• Strong understanding of claim gateway (GW) processing, HIPAA compliance requirements, and claim edits
• Proficiency with Teradata for data querying and analysis
• Strong experience executing and validating REST APIs
• Expert level skill in forming and analyzing complex SQL queries
• Proven experience analyzing and triaging production defects
• Experience developing design and/or mapping documents for system integrations