Technical Support Representative - Claims EDI

• Provides technical and customer support for Regulatory Reporting Solutions EDI Claims system to:
• CMS (Centers for Medicare and Medicaid Services) clients
• Workers’ Compensation FROI/SROI clients
• Auto Trigger clients

Technical Knowledge & Analysis

• Demonstrates extensive knowledge of the IAIABC standard across all Releases
• Conducts comprehensive business analysis of:
• Jurisdictional Requirements
• Client import files
• Baseline data
• Trigger rules
• Sequencing/stacking rules
• Jurisdictional acknowledgement files
• Performs import/export testing of IAIABC flat files and XML formats
• Conducts extensive testing to troubleshoot product bugs and defects
• Monitors and resolves system alerts
• SQL proficiency
• Utilizes SQL to query databases, extract relevant data, and generate custom reports for analysis and troubleshooting.
• Applies database querying expertise to identify patterns, resolve client issues, and support data-driven decision making

Client Support & Regulatory Expertise

• Serves as liaison between clients and jurisdictions
• Analyzes and provides feedback to clients on:
• Jurisdictional requirements
• IAIABC requirements for all Releases
• New and updated state implementations
• Assists clients with claim rejections

Process Improvement & Documentation

• Proposes solutions for product enhancements and defects
• Assists with maintaining system and process documentation

• 2+ years related experience or 1 year related experience and a college degree or medical/technical certification required
• Understanding of IAIABC
• Understanding of Workers’ Compensation Claims Reporting
• Familiar with workcomp.net or previous industry experience
• Workers’ compensation knowledge/background required

We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $18.65 - $27.40 hourly, and will be based on a number of additional factors including skills, experience, and education.

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you’re supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you’ll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.