Role: EDI Analyst
Required Experience: 8 to 10 years (relevant exp. 3 to 6 years in EDI domain)
Key Responsibilities
• 834 Operations: Process, monitor, and validate inbound and outbound ANSI X12 834 enrollment files under HIPAA 5010 standards, ensuring timely, accurate, and complete data exchange with employer groups, TPAs, and partner platforms.
• Trading-Partner Onboarding: Onboard new trading partners — gather companion-guide requirements, configure maps and connections, coordinate test files, and move partners from testing into production.
• Issue Resolution: Research and resolve enrollment discrepancies, file rejections, and reconciliation errors; analyze member add/change/term transactions and coordinate corrections with internal teams and external partners.
• Reconciliation: Perform routine eligibility and discrepancy reconciliation between EDI feeds and the core enrollment/policy-admin system; identify root causes and drive corrective action.
• Mapping & Documentation: Create, test, and maintain EDI maps, translation rules, and trading-partner specifications; author and update companion guides and standard operating procedures.
• Monitoring: Monitor EDI gateway/clearinghouse activity, file transmission schedules (SFTP/FTP), acknowledgments (TA1/999), and error queues; escalate and follow through on failures.
• Cross-Functional Support: Partner with IT, enrollment, billing, and account-management teams to support open enrollment, plan-year setup, group implementations, and renewals.
• Compliance: Ensure all data handling complies with HIPAA privacy/security requirements and internal data-governance and audit controls.
• Reporting: Produce status reports, metrics, and audit trails on file-processing volumes, error rates, and partner SLAs.
Required Qualifications
• 3–5 years of hands-on EDI experience in healthcare, insurance, or benefits administration.
• Demonstrated working knowledge of the ANSI X12 834 transaction set and HIPAA 5010 standards (834 required; familiarity with 820, 270/271, and 837/835 is a plus).
• Experience processing enrollment/eligibility files for a payer, carrier, TPA, or benefits-administration platform.
• Solid understanding of EDI file structure (loops, segments, elements, qualifiers) and the ability to read and interpret raw 834 files.
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