Lead Edifecs Analyst

We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform's EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations.

Deep, current, hands‑on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build.

• Serve as the primary client-facing technical lead for Edifecs-based EDI integration across the core administration platform (claims, eligibility, enrollment, encounters,remittance)
• Own end-to-end design of Edifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277)
• Lead requirements-gathering and solution-design sessions directly with client business, compliance, and technical stakeholders
• Translate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live
• Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance
• Own escalation and resolution of complex production issues across Edifecs EDI flows, coordinating across client, offshore, and platform teams
• Partner with architecture and platform teams to align Edifecs-based integration with the broader core administration platform roadmap, including modernization initiatives
• Define and enforce standards for Edifecs configuration management, version control, testing, and change management
• Own status reporting andrisk/issue communication to client stakeholders and program leadership
• Drive adoption of AI-assisted engineering practices across the Edifecs analyst team

• Bachelor's degree in Computer Science, Engineering, or a related field
• 12–15 years of experience in healthcare EDI/integration engineering, with deep, hands‑on expertise in the Edifecs product suite (e.g., Spec Builder, XEngine, Transaction/EDI Gateway,Encounter Management)
• Strong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components
• Strong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837(remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response)
• Proven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment
• Experience directly managing client relationships and leading distributed onshore/offshore technical teams
• Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules)
• Excellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders

• Practical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation
• Able to critically review andvalidate AI-generated maps, code, and configurations for correctness and regulatory compliance before deployment
• Able to define and enforce standards for responsible AI tool usage across the team, including strict prohibitions on entering PHI, member data, or…