Edifecs Business Analyst (Healthcare EDI / Claims) | Richardson, TX |

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We have an immediate requirement mentioned below with one of our client. Kindly please share your updated resumes to

Job title: Edifecs Business Analyst (Healthcare EDI / Claims)

Location: Richardson, TX

Job Details:

Must Have Skills

• BA experience in Encounters, Claims management and very strong in SQL is a must.
• Understanding of EDIFECS Product platform tools like Spec Builder, defining TP, Application manager, Transaction manager etc..
• Healthcare EDI Transactions 834 , 835 , 837 ( detailed understanding of file loops, segments, key attributes)

Nice to have skills

• SQL Proficiency
• Requirement Analysis and Design

Detailed Job Description

• BA experience in Encounters, Claims management and very strong in SQL is a must. Healthcare EDI Transactions 834 , 835 , 837 detailed understanding of file loops, segments, key attributes Understanding of EDIFECS Product platform tools like Spec Builder, defining TP, Application manager, Transaction manager etc.. Source to Target STTM translated file against transformation rules, etc. Knowledge on Edifecs encounter management. Hands on experience on defining custom rules and validation. Hands on expert

Mandatory skills

• Strong EDIFECS ( 9.3) Developer proficient in EDIFECS MAPs and understands core concepts of building EDIFECS Profilers and deploying them.
• 3 to 5 years’ experience in Edifecs Spec Builder, XE Manager, and XES Manager (XEngine/XEServer) with good knowledge of Groovy scripting and rule creation.
• Expertise in Transformations and good understanding of EDI transactions, specifically EDI 834 format, Segments and Loops.
• HC domain understanding of Enrolment, Plan, Group setup rules.

Desirable / Add On

• Hands-on experience with Edifecs Enrolment Management (ENR) product, managing enrolment data (not just EDI 834, but custom formats) and customizing proprietary fields received from different partners.
• Capable of merging multiple EDI files (e.g., 277CA) into a single consolidated file, split files with strong understanding of EDI standards and transaction structures.
• Expertise in AWS, as CIGNA deploys into Cloud.

Minimum years of experience

• 10 years

Top 3 responsibilities you would expect the Subcon to shoulder and execute

• Experienced BA with good knowledge in Encounters, Claims management and very strong in SQL is a must.
• Able to mentor the team
• Interact with client on a regular basis