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.
Strong SQL or data-analysis skills for querying, validating, and reconciling enrollment data.
Experience with EDI translators/mapping tools and secure file-transfer protocols (SFTP/FTP, PGP
encryption).
Excellent analytical, problem-solving, and documentation skills with strong attention to detail.
Effective written and verbal communication; able to work directly with internal teams and external
trading partners.
Ability to work fully onsite and manage multiple priorities under enrollment deadlines.
Preferred Qualifications
Experience with EDI/integration platforms such as TIBCO, IBM Sterling, Cleo, BizTalk, Edifecs, or
a comparable mapping/translation tool.
Familiarity with benefits-administration or enrollment platforms (e.g., bswift, Benefitfocus,
Businessolver, Workday, or similar).
Knowledge of group, voluntary, supplemental health, or life & annuity product enrollment.
Job Description EDI Analyst, Benefits Enrollment (834) | Page 2
Exposure to open-enrollment cycles and large-volume group implementations.
Experience with ticketing/workflow tools (e.g., Jira, ServiceNow) and basic scripting (Python,
PowerShell, or shell) for automation.
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