Lead EDI Specialist

About the role

Lead reconciliation efforts for Core Self-Funded Enrollment Operations to ensure that key systems are updated.

Review complex inbound 834 and alt 834 file issues in pre-edit/post-release to develop best practices for analysis, reconciliation, and resolution.

Responsible for identifying process improvement opportunities that can enhance quality and efficiency without sacrificing service.

Liaison between Core Self-Funded Enrollment Operations and BTS/Compliance/Marketing/Client Implementation for enrollment impacting initiatives.

Act as subject matter expert for group requests and coordinate technical/process changes.

Document/prioritize system limitations and coordinate with HealthEdge/BTS to identify technical solutions or automation opportunities.

Successfully manage the flow of inbound EDI files for Core SF client business.

Develop and document procedures/job aides/service alerts/policies for enrollment processes.

Manage initial enrollment file loads for new client installations.

Assist and train team members as needed.

Manage team inventory activity.

Lead enrollment related issues resolution for Enrollment Resolver Group.

Organize/disperse team project work to other team members.

Work on ad-hoc projects as requested.

Responsible for managing all robotic process automation (RPA) work for the business area.

Responsibilities

• Lead reconciliation efforts for Core Self-Funded Enrollment Operations to ensure that key systems are updated.
• Review complex inbound 834 and alt 834 file issues in pre-edit/post-release to develop best practices for analysis, reconciliation, and resolution.
• Identify process improvement opportunities that can enhance quality and efficiency without sacrificing service.
• Liaison between Core Self-Funded Enrollment Operations and BTS/Compliance/Marketing/Client Implementation for enrollment impacting initiatives.
• Act as subject matter expert for group requests and coordinate technical/process changes.
• Document/prioritize system limitations and coordinate with HealthEdge/BTS to identify technical solutions or automation opportunities.
• Successfully manage the flow of inbound EDI files for Core SF client business.
• Develop and document procedures/job aides/service alerts/policies for enrollment processes.
• Manage initial enrollment file loads for new client installations.
• Assist and train team members as needed.
• Manage team inventory activity.
• Lead enrollment related issues resolution for Enrollment Resolver Group.
• Organize/disperse team project work to other team members.
• Work on ad-hoc projects as requested.
• Manage all robotic process automation (RPA) work for the business area.

Qualifications

• Ability to work and coordinate enrollment process and Analytics for Core Self-Funded Enrollment Operations.
• Represent Core Self-Funded Enrollment Operations during customer integration projects, operational meetings between IBC divisions, new implementations, integration and new product development, key control audits, regulatory examinations, interaction with Health Edge (or other vendors).
• Acute knowledge of EDI & enrollment systems. Understanding of XML/ANSI 834/HIPAA X12 transactions is beneficial but not required.
• Must possess the ability to interface with internal/external customers at various levels.
• Demonstrate experience in training & development.
• Willingness to work in a fast-paced, challenging environment.
• Detail oriented and organized, with exceptional prioritization skills.
• Ability to effectively communicate with senior management, supervisors, peers, and clients.
• Proficient in Microsoft Applications.
• Proven process improvement methodology and driving change management.
• Requires an extensive knowledge of EDI Portal functionality and managing inbound EDI enrollment file activity.
• Experience in the Health Rules system platform, understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation.

Skills

• Ability to work and coordinate enrollment process and Analytics for Core Self-Funded Enrollment Operations.
• Represent Core Self-Funded Enrollment Operations during customer integration projects, operational meetings between IBC divisions, new implementations, integration and new product development, key control audits, regulatory examinations, interaction with Health Edge (or other vendors).
• Acute knowledge of EDI & enrollment systems. Understanding of XML/ANSI 834/HIPAA X12 transactions is beneficial but not required.
• Must possess the ability to interface with internal/external customers at various levels.
• Demonstrate experience in training & development.
• Willingness to work in a fast-paced, challenging environment.
• Detail oriented and organized, with exceptional prioritization skills.
• Ability to effectively communicate with senior management, supervisors, peers, and clients.
• Proficient in Microsoft Applications.
• Proven process improvement methodology and driving change management.
• Requires an extensive knowledge of EDI Portal functionality and managing inbound EDI enrollment file activity.
• Experience in the Health Rules system platform, understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation.

Benefits

Not specified.

Pay

Not specified.

Schedule

Not specified.

Other

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

Equal Employment Opportunity

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Agency Disclaimer

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.