Job Details

Job DescriptionJob Description
Claims Business Operations AnalystDetail-oriented and analytical Claims Business Operations Analyst to manage, analyze, and optimize our X12 Electronic Data Interchange (EDI) processes and transactions, ensuring seamless data exchange between internal systems and external partners.Key Responsibilities:

• Manage day-to-day EDI operations, including setup, configuration, and troubleshooting of EDI transactions.
• Coordinate with internal teams, trading partners, and third-party vendors to implement, monitor, and optimize EDI processes.
• Analyze and map EDI transactions, primarily 837 Claims and Pharmacy Fixed width files, ensuring data integrity and accuracy.
• Investigate and resolve EDI errors and rejections, working closely with IT and business teams to resolve issues in a timely manner.
• Develop and maintain documentation for EDI processes, procedures, and transaction mappings.
• Perform data validation and testing for new and updated EDI implementations.
• Collaborate with technical teams to ensure that system upgrades, maintenance, and changes do not disrupt EDI functionality.

Required Skills and Qualifications:

• Good understanding & working knowledge of EDI standards (ANSI X12, HIPAA) and file formats (XML, CSV).
• Working knowledge of Healthcare Claims processing
• Ability to analyze data, troubleshoot issues, and communicate effectively with both technical and non-technical stakeholders.
• Excellent attention to detail and problem-solving skills.
• Ability to manage multiple partners, vendors simultaneously.

Qualifications:

• Bachelor's degree in Business Administration, Information Systems, Computer Science, or related field.
• 3+ years of experience in EDI operations, preferably in the healthcare, insurance, or supply chain industry.
• Familiarity with SQL for querying and data analysis.
• Knowledge of HIPAA compliance requirements and healthcare data regulations.

Compensation: $45 - $60 per hour