Title: Sr. EDI Analyst
- We’re looking to bring in a Sr. EDI Analyst.
- This individual will play a critical role in supporting enrollment operations, with a strong focus on EDI 834 transactions, marketplace enrollment, and Open Enrollment readiness.
- The ideal candidate will possess deep health plan enrollment expertise, be well-versed in EDI 834 file structures and processing, and have experience translating complex business requirements into technical solutions while collaborating across both business and IT teams.
Ideal Candidate
- The successful candidate is a seasoned healthcare EDI professional who understands both the technical and operational aspects of enrollment.
- They are comfortable working independently, collaborating with cross-functional teams, and helping ensure smooth enrollment operations during critical Open Enrollment periods.
Key Responsibilities
- Lead the development, validation, and testing of EDI 834 enrollment files.
- Troubleshoot enrollment file issues and identify root causes.
- Interpret enrollment business rules and translate them into technical specifications.
- Provide guidance on state-specific and Marketplace/Open Enrollment requirements.
- Create detailed technical enrollment scenarios to support system testing and implementation.
- Convert business needs into clear technical requirements and functional documentation.
- Define expected system behavior and validate enrollment processing.
- Support enrollment operations teams by resolving complex enrollment and eligibility issues.
- Document business and technical requirements, workflows, and process documentation.
- Develop process flows and workflow diagrams.
- Act as a liaison between business stakeholders and IT teams to ensure successful implementation of enrollment initiatives.
- Monitor regulatory and Marketplace rule changes, particularly those impacting Open Enrollment.
- Interpret New York State Marketplace enrollment requirements and ensure compliance.
- Assess downstream impacts of enrollment and eligibility changes across integrated systems.
- Support planning, testing, and readiness activities for Open Enrollment.
Required Qualifications
- Extensive experience working with EDI 834 Enrollment transactions within a health plan environment.
- Strong knowledge of health plan enrollment and eligibility processes.
- Experience supporting Marketplace/Open Enrollment initiatives.
- Ability to interpret complex business rules and convert them into technical requirements.
- Experience documenting business requirements, technical specifications, and process flows.
- Strong analytical and troubleshooting skills.
- Excellent communication skills with the ability to work effectively across business and technical teams.
Preferred Qualifications
- Experience working with New York State Marketplace enrollment requirements.
- Familiarity with CMS and state exchange enrollment regulations.
- Experience assessing downstream impacts across integrated healthcare systems.
- Prior experience supporting annual Open Enrollment planning and execution.
Flexible work from home options available.
