Manager – EDIFECS - Healthcare EDI & Core Admin Platform

Location: Onshore – United States. Experience: 10–12 years.

About the role

You’ll be particularly successful in this role if you are still technically hands-on and have spent a meaningful part of your career working with EDIFECS in U.S. healthcare payer environments. We’re looking for someone who understands healthcare EDI beyond terminology—you have personally worked with EDIFECS configurations, transaction mapping, trading partners, HIPAA X12 flows, production failures, and high-volume payer integrations. This is a Manager-level role that remains close to the technology. You should be comfortable mentoring and guiding technical teams while still being able to get into EDIFECS configurations, integration issues, debugging, and production troubleshooting yourself.

We are looking for a Senior Edifecs Analyst to build, configure, and support the EDI integration layer of our large healthcare core administration platform. This is an execution-focused, hands-on role: you will implement trading partner configurations, transaction maps, and validation rules under the direction of the onsite Lead Edifecs Analyst and provide day-to-day production support for high-volume EDI transaction processing.

Responsibilities

• Build, configure, and maintain Edifecs trading partner configurations, transaction maps, and validation rules for X12 transactions (270/271, 834, 835/837, 275, 276/277)
• Develop and customize J2EE-based components to extend Edifecs functionality and support integration with the core administration platform
• Implement and maintain data models and queries across MongoDB, PostgreSQL, and Oracle databases supporting EDI processing
• Execute unit, integration, and end-to-end testing of Edifecs configurations and EDI transaction flows
• Provide day-to-day production support for EDI transaction processing, including troubleshooting, debugging, and resolving transaction failures and rejections
• Support onboarding of new trading partners, including testing and certification of EDI transaction exchanges
• Document Edifecs configurations, mapping specifications, and support runbooks
• Collaborate with the onsite lead and client stakeholders on requirements clarification and design validation
• Mentor Technical Leads and Analysts to drive delivery efficiency and technology excellence
• Participate in code/configuration reviews and follow established Edifecs and EDI development standards
• Support broader platform modernization initiatives by providing EDI/Edifecs subject matter expertise as needed

Required Qualifications

• Bachelor's degree in Computer Science, Engineering, or a related field
• 10–12 years of experience in healthcare EDI/integration engineering, with strong, hands-on experience in the Edifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway)
• Strong, hands-on experience with J2EE for customizing and extending Edifecs and related integration components
• Strong, hands-on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Strong working knowledge of core HIPAA X12 EDI transactions: 270/271, 834, 835/837, 275, and 276/277
• Experience building, testing, and supporting production EDI transaction flows in a health plan/payer environment
• Strong debugging and production-support skills for high-volume EDI transaction processing
• Good written and verbal communication skills for collaborating with onsite leads and client stakeholders

AI Knowledge & AI-Assisted Development

• Daily, practical use of AI coding/assistant tools to accelerate Edifecs map/transformation development, J2EE code, and test-case creation
• Able to critically review and validate AI-generated code, maps, and configurations for correctness before deployment
• Understanding of secure and compliant AI tool usage, including never entering PHI, member data, or other sensitive information into prompts or external AI tools
• Able to identify where AI-driven automation can improve day-to-day EDI development, testing, or support efficiency

Preferred Qualifications

• Experience with health plan/payer core administration systems (e.g., Facets, QNXT, HealthRules)
• Exposure to CAQH CORE operating rules
• Experience with mainframe or cloud-based integration patterns supporting EDI processing
• Relevant certifications: Edifecs product certifications