EDI Analyst

Title:

Sr. EDI Analyst

We’re looking to bring in a Sr. EDI Analyst.

This individual will play a critical role in supporting enrollment operations, with a strong focus on EDI 834 transactions, marketplace enrollment, and Open Enrollment readiness.

The ideal candidate will possess deep health plan enrollment expertise, be well‑versed in EDI 834 file structures and processing, and have experience translating complex business requirements into technical solutions while collaborating across both business and IT teams.

• The successful candidate is a seasoned healthcare EDI professional who understands both the technical and operational aspects of enrollment.
• They are comfortable working independently, collaborating with cross‑functional teams, and helping ensure smooth enrollment operations during critical Open Enrollment periods.

• Lead the development, validation, and testing of EDI 834 enrollment files.
• Troubleshoot enrollment file issues and identify root causes.
• Interpret enrollment business rules and translate them into technical specifications.
• Provide guidance on state-specific and Marketplace/Open Enrollment requirements.
• Create detailed technical enrollment scenarios to support system testing and implementation.
• Convert business needs into clear technical requirements and functional documentation.
• Define expected system behavior and validate enrollment processing.
• Support enrollment operations teams by resolving complex enrollment and eligibility issues.
• Document business and technical requirements, workflows, and process documentation.
• Develop process flows and workflow diagrams.
• Act as a liaison between business stakeholders and IT teams to ensure successful implementation of enrollment initiatives.
• Monitor regulatory and Marketplace rule changes, particularly those impacting Open Enrollment.
• Interpret New York State Marketplace enrollment requirements and ensure compliance.
• Assess downstream impacts of enrollment and eligibility changes across integrated systems.
• Support planning, testing, and readiness activities for Open Enrollment.

• Extensive experience working with EDI 834 Enrollment transactions within a health plan environment.
• Strong knowledge of health plan enrollment and eligibility processes.
• Experience supporting Marketplace/Open Enrollment initiatives.
• Ability to interpret complex business rules and convert them into technical requirements.
• Experience documenting business requirements, technical specifications, and process flows.
• Strong analytical and troubleshooting skills.
• Excellent communication skills with the ability to work effectively across business and technical teams.

• Experience working with New York State Marketplace enrollment requirements.
• Familiarity with CMS and state exchange enrollment regulations.
• Experience assessing downstream impacts across integrated healthcare systems.
• Prior experience supporting annual Open Enrollment planning and execution.

Flexible work from home options available.