EDI Analyst

Responsibilities Lead the development, validation, and testing of EDI 834 enrollment files. Troubleshoot enrollment file issues and identify root causes. Interpret enrollment business rules and translate them into technical specifications. Provide guidance on state‑specific and Marketplace/Open Enrollment requirements. Create detailed technical enrollment scenarios to support system testing and implementation. Convert business needs into clear technical requirements and functional documentation. Define expected system behavior and validate enrollment processing. Support enrollment operations teams by resolving complex enrollment and eligibility issues. Document business and technical requirements, workflows, and process documentation. Develop process flows and workflow diagrams. Act as a liaison between business stakeholders and IT teams to ensure successful implementation of enrollment initiatives. Monitor regulatory and Marketplace rule changes, particularly those impacting Open Enrollment. Interpret New York State Marketplace enrollment requirements and ensure compliance. Assess downstream impacts of enrollment and eligibility changes across integrated systems. Support planning, testing, and readiness activities for Open Enrollment. Requirements Extensive experience working with EDI 834 Enrollment transactions within a health plan environment Strong knowledge of health plan enrollment and eligibility processes Experience supporting Marketplace/Open Enrollment initiatives Ability to interpret complex business rules and convert them into technical requirements Experience documenting business requirements, technical specifications, and process flows Strong analytical and troubleshooting skills Excellent communication skills with the ability to work effectively across business and technical teams. Core Competencies Demonstrates expertise in EDI 834 Enrollment transactions and health plan enrollment processes, with a strong ability to translate complex business rules into technical specifications. Proficient in documentation, troubleshooting, and compliance with Marketplace/Open Enrollment requirements. Hard Skills Technical Specifications Process Flows Workflow Diagrams System Testing Enrollment Processing Validation Soft Skills Excellent Communication Skills Collaboration Across Teams Industry Keywords Enrollment File Issues Business Rules Interpretation Regulatory Compliance New York State Marketplace Requirements Eligibility Changes Assessment #J-18808-Ljbffr