We are seeking an experienced EDI Analyst with strong expertise in ANSI X12 834 transactions and HIPAA 5010 standards to support a leading healthcare/insurance client. The ideal candidate will have hands-on experience managing enrollment and eligibility EDI transactions, onboarding trading partners, troubleshooting EDI issues, and ensuring seamless data exchange between business partners and internal systems.
Key Responsibilities
- Process, monitor, and validate inbound and outbound ANSI X12 834 enrollment files in compliance with HIPAA 5010 standards.
- Manage trading partner onboarding, including gathering requirements, configuring EDI maps, coordinating testing, and supporting production deployments.
- Investigate and resolve enrollment discrepancies, file rejections, and reconciliation issues.
- Perform eligibility and enrollment reconciliation between EDI transactions and core enrollment systems.
- Create, maintain, and enhance EDI maps, translation rules, companion guides, and technical documentation.
- Monitor EDI gateways, SFTP/FTP transmissions, acknowledgments (TA1/999), and error queues to ensure uninterrupted file processing.
- Collaborate with IT, Enrollment, Billing, and Account Management teams during implementations, renewals, and open enrollment activities.
- Ensure compliance with HIPAA privacy, security, and internal data governance standards.
- Generate operational reports, processing metrics, audit logs, and SLA tracking reports.
Required Skills & Qualifications
- 8+ years of hands-on EDI experience in Healthcare, Insurance, or Benefits Administration.
- Strong expertise in ANSI X12 834 transactions and HIPAA 5010 standards.
- Experience processing enrollment and eligibility files for healthcare payers, carriers, TPAs, or benefits administration platforms.
- Strong understanding of EDI file structures, including loops, segments, elements, and qualifiers.
- Proficiency in SQL for data validation, reconciliation, and analysis.
- Experience with EDI mapping and translation tools.
- Hands-on experience with secure file transfer technologies (SFTP/FTP) and PGP encryption.
- Strong analytical, troubleshooting, documentation, and communication skills.
- Ability to manage multiple priorities in a fast-paced environment.
Preferred Qualifications
- Experience with EDI platforms such as IBM Sterling, TIBCO, Cleo, BizTalk, Edifecs, or similar tools.
- Experience with benefits administration platforms such as bswift, Benefitfocus, Businessolver, Workday, or equivalent.
- Knowledge of ANSI X12 820, 270/271, 837, and 835 transaction sets.
- Experience supporting open enrollment cycles and high-volume implementations.
- Familiarity with Jira, ServiceNow, or similar ticketing tools.
- Basic scripting knowledge using Python, PowerShell, or Shell scripting is an advantage.
Why Join?
- 100% Remote Opportunity
- 6-Month Contract with Potential Extension
- Opportunity to work on enterprise healthcare and insurance EDI transformation projects
- Collaborative and fast-paced work environment
To apply for this job email your details to anup@praxisconsultants.in