Description

Define and document requirements for EDI initiatives within a payer environment, translating business needs into functional specifications for technical teams.

This role is on-site.

Responsibilities

• Partner with business teams to define requirements for Claims, Provider Portal, and Customer Service Portal efforts.
• Review EDI transactions (837, 835, 270/271) for accuracy and HIPAA 5010 X12 compliance.
• Translate business needs into functional specifications for technical teams.
• Support testing and validate solutions before go-live.

Required Skills

• 5+ years as a Business Analyst within health insurance (payer).
• Deep understanding of EDI standards (HIPAA 5010, X12).
• Hands-on experience with FACETS.
• Familiarity with health plan operations beyond claims.
• Excellent communication skills for cross-functional collaboration.

Preferred Skills

• Agile/Scrum experience.
• Edifecs experience.

Key Skills

Education

Any Gradute