Lead Edifecs Analyst

We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform's EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations. Deep, current, hands‑on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build. KeyResponsibilities: Serve as the primaryclient-facing technical lead for Edifecs-based EDI integration across the coreadministration platform (claims, eligibility, enrollment, encounters,remittance) Own end-to-end design ofEdifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277) Lead requirements-gathering andsolution-design sessions directly with client business, compliance, andtechnical stakeholders Translate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance Own escalation and resolutionof complex production issues across Edifecs EDI flows, coordinating acrossclient, offshore, and platform teams Partner with architecture andplatform teams to align Edifecs-based integration with the broader coreadministration platform roadmap, including modernization initiatives Define and enforce standardsfor Edifecs configuration management, version control, testing, and changemanagement Own status reporting andrisk/issue communication to client stakeholders and program leadership Drive adoption of AI-assistedengineering practices across the Edifecs analyst team Required Qualifications: Bachelor's degree in ComputerScience, Engineering, or a related field 12–15 years of experience inhealthcare EDI/integration engineering, with deep, hands‑on expertise in theEdifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway,Encounter Management) Strong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components Strong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837(remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response) Proven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment Experience directly managing client relationships and leading distributed onshore/offshore technical teams Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules) Excellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders AI Knowledge & AI‑Assisted Development (Required): Practical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation Able to critically review andvalidate AI-generated maps, code, and configurations for correctness andregulatory compliance before deployment Able to define and enforcestandards for responsible AI tool usage across the team, including strictprohibitions on entering PHI, member data, or other sensitive information intoprompts or external AI tools Able to identify opportunitieswhere AI-driven automation can improve EDI mapping, testing, or documentationefficiency, and lead adoption across onshore/offshore teams Comfortable evaluating andchampioning AI-assisted approaches as part of broader platform modernizationinitiatives Preferred Qualifications: Direct experience working foror with a health plan/payer organization on core administration systems (e.g.,Facets, QNXT, HealthRules) CAQH CORE certification orhands-on operating-rule compliance experience Experience integrating Edifecswith mainframe or cloud-based core administration platforms Relevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications You can always press Enter to continue #J-18808-Ljbffr Simplify Alpha