Position Description

Join CGI!

CGI is seeking a results-oriented Senior Analyst to join our growing edits team. This role will be responsible for expansively growing CGI’s edits library and driving value through the identification and prevention of improper payments.

Requirements

- Bachelor’s degree in Computer Science, Engineering, or a related field (or equivalent practical experience).
- Conversational English level B2 or higher.
- 5+ years of experience in payment integrity, claims analytics, medical policy, or coding
- Strong knowledge of CPT/HCPCS, ICD-10, DRG, APC/OPPS, NCCI bundling policies
- Coding certifications: CPC, CCS, COC, CPMA, RHIA, RHIT
- Experience in prepay editing or post-pay audit logic

Responsibilities
- Edit Development &
- Implementation
- Identify high-impact edit opportunities using claim data analysis
- Translate medical policy, CMS rules, coding guidance, and industry best practices into actionable edit logic
- Create rule specifications (conditions, exclusions, thresholds, flags)
- Design validation datasets and perform pre-deployment testing
- Edit Monitoring &
- Optimization
- Track edit performance, yield, false positives, provider abrasion, and ROI
- Continuously refine edits based on results, coding updates, and provider behavior
- Maintain inventory of active edits with documentation and version control
- Identify obsolete or low-value edits and retire/update accordingly
- Clinical &
- Coding Alignment
- Collaborate with Medical Directors for clinical validation
- Ensure edits comply with CMS coding policies, NCCI, LCD/NCD rules
- Work with internal auditors (RN/coding) to validate appropriateness
- Cross-Functional Collaboration
- Partner with SIU, coding, claims operations, and policy.
- Communicate edit design and rationale to leadership
- Work with provider relations to address provider questions or disputes
- Provide reporting and dashboards for edit outcomes
- Governance &
- Documentation




- Maintain edit specifications, business rules, and performance logs
- Ensure each edit has testing artifacts
- Ensure compliance with regulatory and audit requirements (CMS/State)

Nice to have
- SQL skills a plus
- Clinical licensure: RN
- Experience with claims rules platforms a plus (Optum/CES, Cotiviti, McKesson, internal rules engines)
- Creating Professional and Outpatient Edits/Concepts

Additional Skills
- The adecuado candidate has strong claims domain expertise, analytic skills, and a deep understanding of coding, billing, medical policy, and payment integrity concepts.

Apply now! Your future duties and responsibilities

Required Qualifications To Be Successful In This Role

Together, as owners, let’s turn meaningful insights into action.

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.

That same commitment to fairness extends to how we use technology. To support our recruitment team, AI tools may be used to help assess applications though they never replace human judgement. All hiring decisions remain entirely in the hands of our recruitment professionals.

Come join our team—one of the largest IT and business consulting services firms in the world.

📌 Senior Analyst, Edits (Bogotá)
🏢 CGI
📍 Bogotá