Benefits Operations Associate, EDI
Supports end-to-end EDI/API benefits implementations by configuring integrations, mapping and testing files, resolving carrier errors, and maintaining post-production connections. Requires 2–4 years of EDI transmission and enrollment or eligibility management experience, strong client communication, and analytical problem-solving skills.
About the job
Responsibilities
- Own end-to-end setup of new EDI/API implementations, including 834, JSON, and carriers’ proprietary files.
- Provide post-production support for client implementations, including carrier requirements gathering, file mapping, testing, error report handling, and discrepancy resolution.
- Act as the primary point of contact with insurance carriers, customers, and brokers to resolve EDI/API transaction issues.
- Identify process gaps and areas for improvement.
- Own productivity metrics and ensure adherence to SLAs.
- Support EDI/API connections after production launch.
Requirements
- 2–4 years of experience with EDI file transmissions, including 834 or proprietary files, and enrollment/member eligibility management.
- Strong written and verbal communication skills.
- Strong project management and organizational skills.
- Excellent client service skills.
- Strong attention to detail, analytical ability, and problem-solving skills.
- Ability to manage multiple tasks and prioritize effectively.
- Knowledge of HIPAA regulations related to benefits enrollment data and PHI handling.
- Basic knowledge of XML or flat-file data formats used alongside 834 EDI.
Nice to Have
- Knowledge of APIs.
Skills
Edi, 834 Edi, APIs, JSON, Xml, Flat Files, HIPAA, Phi, File Mapping, Data Transmission, Enrollment Management, Member Eligibility, Project Management, Sla Management
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