Data Exchange Analyst - Claim Ops (TPA)

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Judi Rx (a public-benefit PBM for self-insured employers), Judi Health™ (full-service health benefit management for employers, TPAs, and health plans), and Judi®, the industry’s leading Enterprise Health Platform that consolidates all claim-administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in U.S. healthcare.

About the role

The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx – JUDI Health and its partners (employers, providers, TPAs). This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims.

Responsibilities

• Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 (claims & remittance), 270/271 (eligibility), 278 (Prior Auth), 276/277 (claim status), 999/TA1 (file-level acknowledgment), and proprietary formats.
• Collaborate with internal teams (Client Services, Claims, IT Development) and external partners (clearinghouses, TPAs) to define data requirements and specifications.
• Onboard, test, and certify new connections and transaction sets with business teams and trading partners.
• Develop and implement data validation rules and processes to ensure accuracy, completeness, and consistency of exchanged data.
• Proactively identify and resolve data discrepancies, errors, and rejections; perform root-cause analysis and implement preventative measures.
• Monitor system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy.
• Provide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problems.
• Document data exchange processes, configurations, and troubleshooting steps.
• Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort.
• Stay current with industry best practices, new technologies, and regulatory requirements related to healthcare data exchange.
• Generate reports on data exchange performance, error rates, and key metrics; analyze data trends to identify potential issues or areas for improvement.
• Participate in projects with Data Exchange impacts, including vendor changes, client migrations, and client add-on requests.

Requirements

• Bachelor’s degree in Computer Science, Information Systems, Healthcare Informatics, or a related field (equivalent work experience may be considered).
• Knowledge of healthcare claim adjudication processes for medical, dental, and vision.
• Strong knowledge of EDI SNIP validations and widely used healthcare EDI tools (e.g., EDIFECS).
• 2+ years of experience in data analysis, data integration, or EDI within the healthcare industry.
• Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice).
• Familiarity with file transfer protocols (FTP, SFTP, FTPS).
• Understanding of HIPAA compliance and other relevant healthcare regulations.
• Proficiency in SQL, Excel, and JSON preferred.

Skills

• Excellent analytical, problem-solving, and critical-thinking skills.
• Strong attention to detail and commitment to data accuracy.
• Ability to analyze complex business problems to discover and resolve root causes.
• Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders.
• Self-motivated, detail-oriented problem solver.
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team.

Schedule

Hybrid – 3 days in-office (locations: NYC, Denver, CO, or Charlotte, NC area).

Pay

• New York, NY: $96,800 – $121,000 USD
• Denver, CO: $88,800 – $111,000 USD
• Charlotte, NC: $80,800 – $101,000 USD