Our client is a leading healthcare benefits technology platform specializing in third-party administration (TPA) and custom healthcare data solutions. They are nationally recognized for enabling employer groups to control healthcare costs through innovative data integration, claims processing, and benefit management tools. The organization partners with numerous payers and healthcare entities, and has earned accolades for its advanced digital infrastructure and focus on improving operational efficiency in the self-funded benefits space.
This role is ideal for professionals with deep experience in healthcare EDI—particularly 834 X12 eligibility files—and hands-on technical skills using C#, SQL, and EDI processing tools. This role will ultimately be a 50/50 split between hands-on development and working with 834s in an implementation role.
The company offers a dynamic and collaborative environment where individuals have a direct impact on process optimization and long-term system modernization.
This is a remote, long-term contract role (12+ months) supporting the Central U.S. time zone.
The Role You’ll Play
As the 834 EDI Specialist/Developer, you will act as the Subject Matter Expert for 834 eligibility feeds, EDI file exchange, and processing initiatives. You’ll partner closely with internal teams and trading partners to build, enhance, and troubleshoot EDI data workflows. Half of your time will be spent developing the files, and the other half will be spent on the actual implementation with the vendor and doing the daily loads. This role mainly involves supporting standard X12-compliant data formats, but will also involve some work with proprietary data formats, requiring experience in secure data transfers, eligibility mapping, and transformation logic.
Manage day-to-day EDI operations for inbound and outbound 834 eligibility feeds.
Troubleshoot EDI issues in collaboration with trading partners and internal business stakeholders.
Develop and maintain C# scripts to enhance and transform 834 and proprietary eligibility files.
Query internal claims systems to extract and validate eligibility data.
Create companion documents and define trading partner requirements.
Support the onboarding and configuration of new trading partners, including setup, testing, and production migration.
Own full lifecycle of EDI testing (unit, QA, regression, and UAT).
Coordinate the implementation of updates and upgrades across internal and partner systems.
Analyze data for quality, accuracy, and compliance with HIPAA and internal standards.
Maintain detailed process documentation and EDI data flow diagrams.
Implement process improvements and automation opportunities.
Ensure adherence to security protocols, including SFTP and best practices for secure file transfer.
Background Profile
Strong hands-on experience with 834 X12 EDI files and eligibility data exchange.
Strong understanding of the ins and outs of working with external vendors to ensure EDI files meet implementation requirements.
Proven experience with C#.NET and MS SQL
Experience analyzing, troubleshooting, and transforming large data sets.
Experience in the healthcare industry, ideally experience working with TPAs.
Background with proprietary eligibility feed formats alongside X12.
Understanding of HIPAA compliance requirements in data exchange.
Experience implementing process improvements and automation strategies.
Working knowledge of SFTP protocols and secure file transfer processes.
Familiarity with EDI platforms such as Gentran, MOVEit, or similar.
Solid understanding of X12 formatting, data segments, and transaction envelopes.
Experience with trading partner setup, onboarding, and communication.
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