Location: The position is a Hybrid role at least once a week in Phoenix, AZ 85021
Description:
The EDI Technical Analyst (Claims) is responsible for supporting, analyzing, testing, and maintaining EDI transactions, integrations, and data exchange processes that support healthcare claims operations. This role partners with business and technical teams to troubleshoot production issues, develop technical documentation, create data mappings, support testing efforts, and ensure the successful exchange of healthcare data between trading partners. The ideal candidate combines strong analytical skills, EDI expertise, SQL proficiency, healthcare systems knowledge, and experience supporting payer platforms such as QNXT to drive operational efficiency and data integrity.
What You Will Do:
- Support, troubleshoot, and resolve EDI production issues related to claims and trading partner transactions.
- Analyze, map, and validate healthcare data exchanges including 270/271, 834, 835, and 837 transactions.
- Develop technical specifications, mapping documents, process flows, and operational procedures.
- Write and maintain SQL queries for production support, reporting, testing, and data validation.
- Perform root cause analysis and collaborate with internal teams to resolve data and integration issues.
- Create and execute test plans, process test files, document results, and support defect resolution activities.
- Utilize tools such as Splunk, App Insights, SOAP UI, and Postman to monitor, troubleshoot, and validate system performance.
- Support API integrations, ETL processes, and enterprise data exchange initiatives.
- Develop dashboards, reports, and monitoring solutions to ensure data quality and transaction integrity.
- Participate in project planning, implementation activities, and continuous process improvement initiatives.
- Maintain compliance with HIPAA requirements and healthcare EDI standards including TR3, CAQH CORE, and Blue Exchange guidelines.
- Participate in on-call support rotations and production incident response activities.
You Will Be Successful If:
- You have hands-on experience supporting QNXT, healthcare claims processing, and EDI transaction workflows within a payer environment.
- You have experience supporting healthcare EDI transactions and claims-related data exchanges.
- You can quickly identify, troubleshoot, and resolve complex data and integration issues.
- You possess strong SQL and data analysis skills and can confidently work with large datasets.
- You effectively translate business requirements into technical solutions and documentation.
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