Lead EDI Analyst

Responsibilities

• Proactively monitor and analyze production EDI activity to ensure data quality, accuracy, and compliance with mapping specifications, regulatory requirements, industry standards, performance benchmarks, and internal policies.
• Continuously monitor system health throughout the day to support real-time EDI transactions and minimize disruptions.
• Work closely with internal stakeholders to support accurate and timely EDI file processing.
• Engage in cross-functional collaboration with internal business and IT teams, along with external partners and vendors, to resolve issues and guarantee smooth EDI operations.
• Cook up with Trading Partners, Account Teams, Providers, and Claims Teams to identify, troubleshoot, and resolve EDI-related issues efficiently.
• Lead EDI initiatives, including new implementations and system upgrades, ensuring timely execution and alignment with business goals.
• Facilitate stakeholder engagement throughout the project lifecycle, maintaining clear communication, accountability, and collaboration across internal teams and external partners.
• Define and document business requirements and mapping specifications for electronic data exchange, ensuring seamless integration between client and internal systems.
• Participate in requirement review sessions with stakeholders, subject matter experts, and trading partners to validate business needs.
• Maintain clear documentation and workflows for EDI changes and mapping updates using Microsoft Word, Excel, PowerPoint, and Visio.
• Collaborate with the Testing Team to design and execute comprehensive test plans and scenarios for defect resolutions, system enhancements, and project initiatives.
• Support end-to-end testing and validate results through detailed review and approval.
• Cook up testing activities with external vendors to ensure alignment, quality, and timely execution of deliverables.
• Provide support for production checkout and monitor post-implementation defect tracking to ensure stability and performance.
• Identify and recommend process improvements to enhance operational efficiency and testing effectiveness.

Qualifications

• Bachelor’s degree from an accredited institution preferred or equivalent work experience
• 7+ years of experience in EDI transaction processing, preferably in a healthcare, managed care or insurance environment
• Strong knowledge of HIPAA EDI standards (especially 270/271, 276/277, 277CA, 278, 837, 835, 999/TA1)
• Experience with EDI tools, translators, and transaction monitoring systems
• Excellent analytical, problem-solving, and communication skills
• Demonstrated ability in planning, organizing, and executing tasks effectively
• Ability to manage multiple priorities in a fast-paced environment
• Strong working knowledge of Microsoft Office suite, including:
• Excel: proficient in creating formulas, using VLOOKUPs, building pivot tables, and performing data analysis
• Word, PowerPoint, and Visio: skilled in developing documentation, creating presentations, and mapping business processes

Additional Preferred Experience

• Working knowledge of SQL to support defect analysis and resolution
• Knowledge of BCBSA Blue Exchange transaction processing