Outbound File Technical Analyst - LH

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.

We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.

Job Summary

The Outbound File Technical Analyst is the SME (subject matter expert) for hundreds of outbound files in many different file layouts and formats for our client’s vendors and works directly with programmers for new file builds and changes to existing files. This position involves analyzing a vendor file layout(s) and the needs of the particular vendor, writing business requirements, meeting with vendors and programmers to ensure understanding, creating test plans and testing scenarios, documenting testing results and collaborating with programmers to achieve the end result and finally providing user sign off for deployment of files to production.

This position requires analytical and critical thinking skills to ensure that programming is accurate based on the needs of a client’s vendor. In addition this position works with team members and other internal customers and external customers by analyzing a question or issue to either provide an explanation or determine if programming changes are needed and work with programmers to implement a change when needed.

Problem solving and sound decision making skills are needed.

Outbound File Intake and Analysis

Understand the overall purpose of why a vendor needs a particular file(s)

Analyze a vendor file layout(s) field by field

Meet with vendor and/or client to obtain additional information when needs are unclear

Facilitate ongoing communication with vendor and/or client

Write detailed business requirements

Meet with programmers to ensure understanding of needs for each field on a file layout

We need to ensure that outbound data files are accurate so a client’s employees have access to services purchased by a client.

An outbound file to a PBM allows customers to obtain prescriptions, other files impact correct claim pricing by a network or allow access to vision or dental services.

If a data analytics vendor is involved, we need to ensure that we are sending the correct claim data so the vendor can provide accurate data to our client regarding how their plans perform and offer solutions to the client for better plan performance.

Outbound File Testing

Create test plans for a specific file(s) based on client and vendor criteria

Create testing scenarios in the test region

Perform review of test files field by field and document testing results. The review and testing cycle may occur multiple times. Collaborate with programmers on solutions to achieve the end result needed.

Track progress and ensure due dates are met

Provide final user sign off after all requirements have been met so programming can be deployed to the production environment

Review and audit 1st production files to ensure production turnover accuracy

This requires a strong understanding of Next Stepp our enterprise data warehouse and the ability to independently create and run SQL queries and review and compare data files.

Work collaboratively with team members, other internal departments and external customers to analyze and research a question, determine a solution and provide an explanation or request programming changes when necessary.

Other duties as needed/assigned

Required

Job Qualifications:

Bachelor’s degree in business or equivalent experience

Minimum of 4 years prior experience working in the insurance or TPA industry in a technical role working with EDI files and/or analyzing and testing electronic data files

Understanding of EDI terminology and file structures

Ability to read, understand and interpret file specifications

Experience with SQL and compare tools like Ultra Edit

Proven problem solving, troubleshooting and analytical skills are essential.

Ability to determine solutions and resolve issues with minimal supervision

Ability to work…