EDI Developer

JOB DESCRIPTION

SUMMARYThe EDI Developer is responsible for designing, developing, and maintaining electronic data interchange (EDI) solutions that support the seamless exchange of data between the TPA’s internal systems (claims, benefits, customer service) and its external partners. The incumbent will use strong programming skills, deep knowledge of data mapping, and experience with EDI integration platforms such as PilotFish to create and maintain systems. The developer will also be involved in ongoing upgrades, patches, and system enhancements related to EDI technology while ensuring compliance with healthcare industry standards and regulations.

Qualifications

• Bachelor's Degree, preferably in a related field such as computer science, or information technology, along with at least 3 years of experience in EDI development or integration engineering roles, is preferred.
• Proven experience with EDI standards (., ANSI X12) and healthcare transaction sets (837, 834, 835, , highly desired.
• Hands-on experience with the PilotFish integration platform or similar ETL tools.
• Proficient in programming languages such as Java, C++, XML, and XSLT.
• Strong understanding of communication protocols used for EDI (SFTP, AS2, HTTPS).
• Experience with database technologies (SQL Server, MySQL) and data warehousing concepts.
• Solid knowledge of data mapping, transformation logic, and integration patterns.
• Experience with system monitoring, error handling, and performance optimization for EDI processing.
• Familiarity with HIPAA compliance and healthcare data security standards.
• Ability to work independently on technical development projects while collaborating with cross-functional teams.
• Excellent troubleshooting and problem-solving abilities.
• Strong analytical skills with attention to detail and data accuracy.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (., facing computer towards wall,
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

EDI Development

• Design, develop and test EDI maps, workflows and transformations for healthcare transactions (., 834 enrollments, 837 claims, 835 remittances, 276/277 claim status).
• Develop, implement, and maintain EDI integration solutions to support various transaction sets.
• Create custom EDI translation maps and business rules to handle partner-specific requirements and data variations.
• Monitor scheduled EDI jobs and proactively resolve errors, ensuring SLAs with trading partners are met.
• Collaborate with internal teams (claims, finance, eligibility) to integrate data with healthcare systems.
• Build and optimize interfaces between internal systems and external trading partners.
• Write scripts, configure protocols (., SFTP, AS2), and ensure secure and reliable data transmission.
• Develop automated validation routines to ensure data quality and completeness before transmission.
• Integrate EDI platforms with other enterprise systems, to ensure smooth data flow.

Partner Communication

• Collaborate with EDI Analysts, business stakeholders and external trading partners to translate requirements into technical solutions.
• Communicate technical concepts effectively to non-technical stakeholders.
• Assist new trading partners with onboarding, testing and validation of transaction sets.
• Support and troubleshoot issues related to data mappings, transformations, and delivery failures.
• Participate in cross-functional meetings to discuss system requirements and project timelines.

Data Integrity and Documentation

• Validate inbound and outbound EDI data for accuracy, completeness and HIPAA compliance.
• Implement automated monitoring and alerting solutions for data integrity and error detection.
• Conduct system upgrades, patches, and performance tuning of EDI infrastructure.
• Maintain comprehensive technical documentation for EDI processes and interfaces, trading partner profiles, connection parameters, and transaction specifications.
• Perform unit testing and complex debugging to ensure accuracy and reliability of EDI transactions.
• Troubleshoot issues, manage existing integrations, and support the ongoing operation of the EDI environment.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client data.
• Maintain and service safety equipment (., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.#LI-Remote