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 and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS)

2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically within the healthcare industry

Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)

Excellent analytical, problem-solving, and critical thinking skills

Familiarity with various file transfer protocols (FTP, SFTP, FTPS)

Understanding of HIPAA compliance and other relevant healthcare regulations

Strong attention to detail and a commitment to data accuracy

Ability to analyze complex business problems to discover and resolve root causes

Proficiency in SQL, Excel, JSON and other technical data skills preferred

Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders

Analyst, Data Exchange Claims Ops (TPA)

Responsibilities