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., * 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.

• 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.

Ideal Candidate

• 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., * 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.