EDI Claims Implementation Specialist

We are seeking an experienced EDI Claims Implementation Specialist to support the implementation, configuration, testing, and maintenance of Electronic Data Interchange (EDI) claims transactions. The role will work closely with business stakeholders, technical teams, and external partners to ensure accurate claims processing, successful system integration, and compliance with industry standards.

Roles and Responsibilities

• Implement and support EDI claims transactions, including 837 (Claims) and 835 (Payment/Remittance Advice).
• Coordinate EDI onboarding, mapping, configuration, testing, and implementation with trading partners.
• Troubleshoot EDI transaction errors, claim rejections, and integration issues.
• Validate EDI files and ensure compliance with applicable transaction standards.
• Collaborate with business, IT, and external partners to resolve implementation issues.
• Develop implementation documentation, test scenarios, and status reports.
• Support production issues and continuous improvements in claims processing workflows.

Required Qualifications

• Experience implementing and supporting EDI claims transactions.
• Strong knowledge of EDI 837 and 835 transactions and X12 standards.
• Experience with EDI mapping, testing, troubleshooting, and trading partner integrations.
• Understanding of claims processing workflows and data validation.
• Strong analytical, problem-solving, communication, and coordination skills.

Preferred Qualifications

• Experience in healthcare claims or payer/provider environments.
• Familiarity with EDI integration platforms, clearinghouses, and HIPAA transaction requirements.
• Experience with end-to-end implementation and production support.