EDI Technical Analyst (Claims) - Hybrid
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Overview
Job Description
HJ Staffing is seeking an EDI Technical Analyst (Claims) to support, analyze, test, and maintain EDI transactions, integrations, and data exchange processes for healthcare claims operations. In this role, you will partner with business and technical teams to troubleshoot production issues, develop technical documentation, create data mappings, and ensure successful data exchange between trading partners.
The ideal candidate combines strong analytical skills, EDI expertise, SQL proficiency, healthcare systems knowledge, and direct experience supporting payer platforms like QNXT to drive operational efficiency and data integrity.
Vital Requirements (Please Read Before Applying)
- Work Location: Must currently reside in Arizona and be able to commute to the Phoenix office (85021) at least one day per week.
- Work Authorization: Must be a US Citizen or Green Card holder. We cannot provide sponsorship now or in the future for this temp-to-hire role.
- Platform Experience: Direct, hands-on experience with the QNXT platform is strongly preferred and must be clearly listed on your resume.
What You Will Do
- Production Support: Support, troubleshoot, and resolve EDI production issues related to claims and trading partner transactions; participate in on-call support rotations.
- Data Analysis & Mapping: Analyze, map, and validate healthcare data exchanges including 270/271, 834, 835, and 837 transactions.
- SQL & Monitoring: Write and maintain SQL queries for production support, reporting, testing, and data validation. Utilize Splunk, App Insights, SOAP UI, and Postman to monitor and validate system performance.
- Testing & Documentation: Create and execute test plans, process test files, document results, and resolve defects. Develop technical specifications, mapping documents, and process flows.
- Integrations: Support API integrations, ETL processes, and enterprise data exchange initiatives while developing dashboards to monitor data quality.
- Compliance: Maintain strict compliance with HIPAA requirements and healthcare EDI standards including TR3, CAQH CORE, and Blue Exchange guidelines.
What You Will Bring
- Education: High School Diploma or GED required; Bachelor's degree in Computer Science, IS, or a related field preferred.
- Experience: 2+ years of hands-on EDI experience supporting healthcare transactions (claims, enrollment, eligibility, or payment).
- Technical Skills: Strong SQL query development and database analysis skills.
- Payer Platform Expertise: Proven experience supporting healthcare payer environments, claims processing systems, and trading partner integrations (QNXT highly preferred).
- Tooling: Experience with testing tools (SOAP UI, Postman) and monitoring/logging tools (Splunk, App Insights). Understanding of API integrations, ETL, and cloud platforms (AWS/Azure) is preferred.
- Bonus Points: Knowledge of the Edifecs EDI platform is a major plus.
You Will Be Successful If:
- You can quickly identify, troubleshoot, and resolve complex data and integration issues.
- You confidently work with large datasets and translate complex business requirements into technical solutions.
- You thrive in a fast-paced environment with competing priorities and deadlines.
- You demonstrate strong communication skills and can easily explain technical concepts to non-technical business stakeholders.
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