Senior EDI Solutions Analyst - Remote

Sr. EDI Solutions Analyst

The opportunity is to lead trading partner integrations from end to end working with a proprietary Medical Management system (MMS) and connecting it to various Claims systems. The focus is on ensuring seamless technical integration for EDI 278 Authorization transactions.

• Monitor daily EDI transaction processing.
• Troubleshoot and resolve any EDI processing issues.
• Serve as implementation team resource for EDI mapping, validation, and testing.
• Prepare and update program documentation, job aids, and related artifacts.
• Schedule and perform ad hoc auditing of systems and databases to support prior authorization transactions.
• Analyze data and measure performance for programs related to prior authorizations, claims, and member eligibility.
• Create process and data flow diagrams for assigned projects.
• Prepare reports for management.
• Identify and communicate processing issues to leadership.
• Prepare and coordinate presentations, training, and educational materials.
• Implement new technologies and processes, including testing and follow‑up.
• Interface with clients, managed care customers, and IT resources as needed.
• Take on special projects as assigned.

• 5+ years of experience in:
  • Healthcare data environment – eligibility, provider, claims, etc.
  • Data mapping and workflow documentation.
  • Healthcare EDI transaction knowledge and expertise.
  • X12 ANSI 278 transaction expertise.
  • EDI transaction mapping.
  • EDI production support and maintenance, including editing and correcting EDI 278N X12 package data for resubmission.
  • EDI testing and validation.
  • Medical Management Systems (MMS) experience.
  • SQL (relational databases such as MySQL, MS SQL, DB2).
  • Microsoft Word, Outlook, Excel (pivot tables, formulas), and Visio experience for process/data flow diagrams.

• Experience building EDI 278 real‑time and batch mode integration services.
• Experience with ETL file management and archive processes.
• Experience with cloud‑based solutions and services.
• Knowledge of claims billing practices, CPT coding, reimbursement processes, 3rd party provider enrollments, claims submissions, EDI/HIPAA transactions, or accounts receivable.
• Ability to write clear technical and functional specifications for authorization data integration services.

• Solid organization skills and attention to detail.
• Excellent communication skills, verbal and written, to interact with various levels of resources internally and externally.

• Dedicated, separate work area with privacy.
• Secure handling of sensitive documents.
• High‑speed internet connectivity approved by United Health Group.

Salary range: $91,700 to $163,700 annually, based on full‑time employment. Additional benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution (subject to eligibility). All benefits are subject to applicable eligibility requirements.

United Health Group is an Equal Employment Opportunity employer under applicable law. Qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.