Lead Edifecs Analyst - Healthcare EDI & Core Admin Platform

We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform’s EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations. Deep, current, hands-on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build., * Serve as the primary client-facing technical lead for Edifecs-based EDI integration across the core administration platform (claims, eligibility, enrollment, encounters, remittance)

• Own end-to-end design of Edifecs trading partner configurations, transaction maps, and validation rules for X12 transactions (270/271, 834, 835/837, 275, 276/277)
• Lead requirements-gathering and solution-design sessions directly with client business, compliance, and technical stakeholders
• Translate complex regulatory, payer, and trading-partner requirements into Edifecs specifications, and validate that the completed build meets those requirements before go-live
• Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance
• Own escalation and resolution of complex production issues across Edifecs EDI flows, coordinating across client, offshore, and platform teams
• Partner with architecture and platform teams to align Edifecs-based integration with the broader core administration platform roadmap, including modernization initiatives
• Define and enforce standards for Edifecs configuration management, version control, testing, and change management
• Own status reporting and risk/issue communication to client stakeholders and program leadership
• Drive adoption of AI-assisted engineering practices across the Edifecs analyst team

Tech Stack: Edifecs (SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management), J2EE, MongoDB, PostgreSQL, Oracle, X12 EDI (270/271, 834, 835/837, 275, 276/277), AI-Assisted Development, * Bachelor’s degree in Computer Science, Engineering, or a related field

• 12-15 years of experience in healthcare EDI/integration engineering, with deep, hands-on expertise in the Edifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management)
• Strong, hands-on expertise in J2EE for customizing and extending Edifecs and related integration components
• Strong, hands-on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837 (remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response)
• Proven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment
• Experience directly managing client relationships and leading distributed onshore/offshore technical teams
• Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions (HIPAA, CAQH CORE operating rules)
• Excellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders

AI Knowledge & AI-Assisted Development (Required)

• Practical, daily use of AI coding/assistant tools to accelerate Edifecs map/transformation development, J2EE customization, and technical documentation
• Able to critically review and validate AI-generated maps, code, and configurations for correctness and regulatory compliance before deployment
• Able to define and enforce standards for responsible AI tool usage across the team, including strict prohibitions on entering PHI, member data, or other sensitive information into prompts or external AI tools
• Able to identify opportunities where AI-driven automation can improve EDI mapping, testing, or documentation efficiency, and lead adoption across onshore/offshore teams
• Comfortable evaluating and championing AI-assisted approaches as part of broader platform modernization initiatives

Preferred Qualifications

• Direct experience working for or with a health plan/payer organization on core administration systems (e.g., Facets, QNXT, HealthRules)
• CAQH CORE certification or hands-on operating-rule compliance experience
• Experience integrating Edifecs with mainframe or cloud-based core administration platforms
• Relevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications, Analysis Skills, Artificial Intelligence (AI), Automation, CMVC (Configuration Management Version Control), Change Management, Cloud Computing, Code Reviews, Communication Skills, Computer Science, Customer Experience, Customer Relations, Customer Relationship Management (CRM), Documentation, Electronic Data Interchange (EDI), HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Healthcare, Healthcare Administration, Java Platform Enterprise Edition (Java EE/J2EE), Leadership, Mainframe Computer, Mentoring, MongoDB, Offshoring, Oil Rig/Platform, Oracle Certifications, Oracle DBA (Database Administrator), Oracle Database, PostgreSQL, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Regulations, Regulatory Compliance, Regulatory Requirements, Requirements Management, Risk, Standards Development, System Integration (SI), Systems Administration/Management, Technical Leadership, Technical Writing, Testing, Writing Skills