EDI Analyst

Position Overview

As part of our continued growth, Zelis is seeking an experienced EDI AnalystII to support and optimize healthcare EDI integrations with a primary focus on ANSI X Electronic Remittance Advice (ERA) transactions. In this role you will troubleshoot complex EDI issues, improve integration processes through automation and AI‑enabled tools, and ensure the accuracy, integrity, and compliance of healthcare payment data while collaborating with cross‑functional teams and external partners.

• Analyze and troubleshoot complex ANSI X (ERA) transactions, identifying processing, formatting, balancing, and compliance issues.
• Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions.
• Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans.
• Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements.
• Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients.
• Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues.
• Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges.
• Leverage AI‑enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency.
• Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities.
• Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements.

• Bachelor’s degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience.
• 5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12835 transactions; experience with 837, 834, and 270/271 is a plus.
• Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation.
• Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes.
• Advanced SQL and data analysis skills;
  Microsoft SQL Server experience preferred.
• Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT;
  Jira, C#, or API experience is a plus.
• Excellent analytical, communication, troubleshooting, and problem‑solving skills, with the ability to mentor junior analysts and collaborate across technical, operational, and client‑facing teams.

Visa sponsorship:
Zelis is unable to proceed with candidates who require visa sponsorship now or in the future.

Zelis is headquartered in the U.S. with multiple locations across the country and in Hyderabad, India. All employee work locations are based on the needs of the position and are determined by the Leadership team. While location expectations vary by role, candidates within approximately 50miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in‑office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range: $65,000.00 – $82,650.00. The base salary is part of a Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives.

• 401k plan with employer match
• Flexible paid time off
• Holidays and parental leaves
• Life and disability insurance
• Health benefits:
  
  medical, dental, vision, and prescription drug coverage

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet…