EDI Analyst

A Little About Us At Zelis, we Get Stuff Done. So, let’s get to it! Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you’ve learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you’ve gained, and the personal interests that shape who you are. Position Overview As part of our continued growth, Zelis is seeking an experienced EDI Analyst II to support and optimize healthcare EDI integrations with a primary focus on ANSI X12 5010 835 Electronic Remittance Advice (ERA) transactions. In this role, you will troubleshoot complex EDI issues, improve integration processes through automation and AI‑enabled tools, and ensure the accuracy, integrity, and compliance of healthcare payment data while collaborating with cross‑functional teams and external partners. What You’ll Do Analyze and troubleshoot complex ANSI X12 5010 835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues. Perform root‑cause analysis, resolve EDI processing issues, and implement preventive solutions. Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans. Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements. Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients. Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues. Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges. Leverage AI‑enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency. Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities. Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements. What You’ll Bring to Zelis Bachelor’s degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience. 5‑7+ years of healthcare EDI experience, including 3‑5+ years supporting HIPAA ANSI X12 835 transactions; experience with 837, 834, and 270/271 is a plus. Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation. Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes. Advanced SQL and data analysis skills; Microsoft SQL Server experience preferred. Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience is a plus. Excellent analytical, communication, troubleshooting, and problem‑solving skills, with the ability to mentor junior analysts and collaborate across technical, operational, and client‑facing teams. Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. #J-18808-Ljbffr