Director of EDI & Inbound Claims Configuration
Molina Healthcare of Illinois
Molina Healthcare is seeking a senior product leadership professional to guide delivery of enterprise products across health plans and compliance workflows. This role directs teams, aligns backlog with business outcomes, and collaborates with engineering, architecture, and operations to ensure scalable, compliant solutions. Key responsibilities include shaping product vision, managing configuration and fee schedules, and driving improvements across critical health plan processes in a remote #J-18808-Ljbffr Molina Healthcare
$136.19k - $170.24k
...confirmation, billing, returns, and customer claims. Design Oracle Fusion Order... ...procedures. Partner with EDI and integration teams to support inbound OEM releases and outbound order acknowledgments... ...design documents, process maps, configuration workbooks, test scenarios,...EDIClaimsFull timeTemporary workVisa sponsorshipRelocation package- ...are seeking an experiencedQNXT Benefit Configuration Analystto support the implementation, enhancement... ...payer operations, benefit plan design, claims processing, SQL, and end-to-end testing.... ...Claims, Enrollment, Provider, Finance, EDI, and Customer Service. Maintain...EDIClaims
- ...Systems Manager leads and oversees system configuration and maintenance activities within the... ...This role is responsible for payer setup, EDI enrollment and management, file... ...workflows to support efficient billing, claims processing, and cash flow. This role partners...EDIClaimsContract work
$105.4k - $207.8k
...when an agentic use case can be reused with light configuration, when it needs substantial extension, and when a client... ...of healthcare data and data standards (e.g., claims, remittances, EMR data, HL7, FHIR, X12 EDI), with the ability to reason through data quality and...EDIClaimsLocal area$95k - $105k
...to streamline EPR compliance and make credible sustainability claims. At rePurpose, we believe a world free of plastic waste is achievable... ...processes. Manage user permissions, field/property configuration, data hygiene, lifecycle stages, pipeline setup, and process documentation...ClaimsLive inWork at officeRemote workFlexible hours3 days per week- ...Epic Payer Platform Lead who has personally configured or led configuration of EPP Capabilities... ...support. Epic Tapestry certification in Claims, E&E, Benefits Engine, CRM, or UM -... ...with Epic integration standards (FHIR R4, EDI X12, CDA/CCDA) as applied to EPP data exchange...EDIClaimsFull timeWork experience placementLive inWork at officeLocal area
$96.8k - $121k
...systems with the industry's first Unified Claims Processing architecture, seamlessly... ...problems Document data exchange processes, configurations, and troubleshooting steps Process... ...~ Strong knowledge and familiarity with EDI SNIP validations and one of the most...EDIClaimsWork experience placementWork at officeLocal areaFlexible hours3 days per week$250k
...everything for our 28 million members. Position Purpose Oversee operations for multiple support functions, including configuration, claims support services, provider relations, call center and field operations. Perform duties as chief liaison between the business...ClaimsFull timePart timeWork at officeRemote workRelocationFlexible hours$144.8k - $181k
...systems with the industry's first Unified Claims Processing™ architecture, seamlessly... ...analytics, stop-loss, client reporting, EDI/data feeds, and external vendors. Design... ...operations, payer/TPA operations, claims configuration, provider relations, or healthcare data-...EDIClaimsContract workLocal areaFlexible hours- ...end lifecycle of DAM platform, from initial implementation and configuration through ongoing support and enhancement Serve as business... ...including controlled vocabularies aligned to channels, audiences, claims, and customer journeys Ensure consistent metadata capture at asset...Claims
$174.8k - $218.5k
...systems with the industry's first Unified Claims Processing architecture, seamlessly... ...and technical readiness. Ensure network configurations align with business goals and client-specific... ...healthcare data exchange standards (EDI transactions such as 837, 835, 270/271,...EDIClaimsContract workLocal areaFlexible hours3 days per week- .... Pharmacy management system selection, configuration, and integration with the EHR and 340B split... ...duplicate-discount prevention; update claims identification and billing processes as... ..., ideally including experience at the Director or Senior Director level within a health...ClaimsContract work
$150.8k - $188.5k
Data Exchange Manager - Claims Operations Judi Health is a health technology company providing benefit... ...healthcare data integrations, client onboarding, EDI transactions, eligibility feeds, claims exchanges, configuration setup, data quality monitoring, and operational...EDIClaimsLocal areaFlexible hours$69.85k - $97.09k
...proactively assisting them with post‑sales installation, configuration, upgrade, troubleshooting and day‑to‑day operational... ...determining financial impact. Analyze and reconcile claims and encounter data, including 837 EDI encounter files for EDPS, RAPS and Edge Server...EDIClaimsLocal areaRemote work- ...built guestrooms with a variety of bedding configurations including king, queen, double/double... ...is responsible for assisting the Director of Human Resources with a variety of Human... ...prescreening interviews. Respond to unemployment claims, maintain unemployment logbook....ClaimsHourly pay
$195k - $215k
...product experience team. This role will shape how customers access, configure, manage, and scale on-platform Vidmob experiences. Our core... ...number, or password, through email. If you receive an email claiming to be from Vidmob that does not come from a @ vidmob.com...ClaimsWork at office$142.6k - $261.5k
...programs. A number of solution “hot spots” exist today, such as in claims, underwriting, policy and billing. Our ambition is to be the C... ...of business and technology architectureApplication configuration/integrationData mapping, conversion, migrationAbility to deliver...ClaimsWork experience placementSummer holidayFlexible hours$240k - $265k
...Summary OpenGov is looking for a Senior Director of HR Operations & Total Rewards to serve... ...instant answers on coverage, costs, and claims. You should bring deep Workday... ...integrity, and audits. You know how to configure Workday to run comp cycles cleanly, manage...ClaimsContract workWork experience placementWork at officeLocal areaFlexible hours- ...Job Description WHAT DOES AN ASSOCIATE DIRECTOR, MEETING SERVICES DO? The Associate Director... ...and execution plans. Support configuration and testing of bureau portals, workflows... ...unsolicited e‑messages, or even text messages claiming to be a legitimate company. Some of...ClaimsWork at officeLocal areaShift workAfternoon shift
- ...seeking a Senior Technical Implementation Manager to lead platform configurations, integrations, and technical implementation initiatives. This... ...Configure platform setups, SFTP connections, and eligibility, claims, and prior authorization files. Manage QA of configurations...ClaimsImmediate startRemote workFlexible hours
- ...solutions that support enrollment, claims, provider, member, care... ...TriZetto Facets platform. Configure and develop Facets batch processes... .... Build and maintain inbound and outbound data integrations... ...healthcare data files including: o EDI 834 o EDI 835 o EDI 837 o EDI...EDIClaimsFull timeRemote work
$85k - $110k
...applications, system infrastructure, network layer, and security configurations understanding of financial reporting processes including... ..., cash management, revenue recognition, IT departments, loans/claims management Experience supervising Associates and Senior Associates...ClaimsFlexible hours- ...operations professional with deep expertise in EDI (Electronic Data Interchange), specifically HIPAA 834 Enrollment and 837 Claims transactions, to lead implementation efforts... .... Oversee testing and validation of inbound and outbound EDI files to ensure compliance...EDIClaimsTemporary workRemote work
$171.6k - $392.1k
...experiences emerging as the most critical "hot spot" alongside claims, underwriting, policy, and billing. Our ambition is to be the... ...Advanced Product Designer, Authentication/Authorization, APIs, and configuration; ability to architect customized solutions that adapt into...ClaimsWork experience placementSummer holidayFlexible hours$75k - $95k
...performance using revenue, margin, service, claims, and operational KPIs. Identify... ...(20%) Identify opportunities to increase inbound and outbound freight volume with existing... ...organizations regarding interchange processes, EDI connectivity, POD management, service standards...EDIClaims- ...Claims Business AnalystDuration-6 – 12 months ++Hybrid 3 Days a week: Charlotte, NC; Chicago, IL; Colorado Springs, CO; Conshohocken,... ...implementation – for each jurisdiction there's different compliance req edi calls; Verisk exp VERY HELPFUL, pbm, medical bill mngt, etd to...EDIClaims3 days per week
$174.8k - $218.5k
...systems with the industry's first Unified Claims Processing architecture, seamlessly... ...timely, and compliant processing of HIPAA EDI transactions and hosted gateway solutions... ...delays. Manage daily operational controls for inbound/outbound files, transaction queues,...EDIClaimsLocal areaFlexible hours- ...their use of Stedi’s API-enabled clearinghouse, focusing on revenue cycle management and EDI-related workflows. You will work with customers to optimize eligibility checks, claims processing, and remittance reconciliation, while relaying insights back to product and engineering...EDIClaims
- ...own the day-to-day revenue cycle for a set of customers, including claim submission, authorizations, payment posting, AR follow-up, and... ...with multiple clearinghouses and payer portals Familiarity with EDI, eligibility verification, or verification of benefits workflows...EDIClaims
$168k - $285.6k
...Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers... ...GitLab. An overview of this role As the Director, Pipeline Excellence you'll help GitLab... ...funnel conversion and velocity across inbound, outbound, partner, and expansion. In your...ClaimsFull timeRemote workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Director of EDI & Inbound Claims Configuration. Be the first to apply!
- academic director New York, NY
- copy director New York, NY
- director of knowledge management New York, NY
- director of college counseling New York, NY
- director of training and development New York, NY
- director of public safety New York, NY
- director of advocacy New York, NY
- director revenue management New York, NY
- director of community outreach New York, NY
- director mba New York, NY



