We are seeking an experienced EDI Analyst with solid expertise in ANSI X12 834 transactions and HIPAA 5010 standards to support a leading healthcare/insurance client. The ideal candidate will have hands-on experience managing enrollment and eligibility EDI transactions, onboarding trading partners, troubleshooting EDI issues, and ensuring seamless data exchange between business partners and internal systems.

Key Responsibilities

- Process, monitor, and validate inbound and outbound ANSI X12 834 enrollment files in compliance with HIPAA 5010 standards.

- Manage trading partner onboarding, including gathering requirements, configuring EDI maps, coordinating testing, and supporting production deployments.

- Investigate and resolve enrollment discrepancies, file rejections, and reconciliation issues.

- Perform eligibility and enrollment reconciliation between EDI transactions and core enrollment systems.

- Create, maintain, and enhance EDI maps, translation rules, companion guides, and technical documentation.

- Monitor EDI gateways, SFTP/FTP transmissions, acknowledgments (TA1/999), and error queues to ensure uninterrupted file processing.

- Collaborate with IT, Enrollment, Billing, and Account Management teams during implementations, renewals, and open enrollment activities.

- Ensure compliance with HIPAA privacy, security, and internal data governance standards.

- Generate operational reports, processing metrics, audit logs, and SLA tracking reports.

Required Skills Qualifications

- 8+ years of hands-on EDI experience in Healthcare, Insurance,



or Benefits Administration.

- Strong expertise in ANSI X12 834 transactions and HIPAA 5010 standards.

- Experience processing enrollment and eligibility files for healthcare payers, carriers, TPAs, or benefits administration platforms.

- Strong understanding of EDI file structures, including loops, segments, elements, and qualifiers.

- Proficiency in SQL for data validation, reconciliation, and analysis.

- Experience with EDI mapping and translation tools.

- Hands-on experience with secure file transfer technologies (SFTP/FTP) and PGP encryption.

- Robust analytical, troubleshooting, documentation, and communication skills.

- Ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

- Experience with EDI platforms such as IBM Sterling, TIBCO, Cleo, BizTalk, Edifecs, or similar tools.

- Experience with benefits administration platforms such as bswift, Benefitfocus, Businessolver, Workday, or equivalent.

- Knowledge of ANSI X12 820, 270/271, 837, and 835 transaction sets.

- Experience supporting open enrollment cycles and high-volume implementations.

- Familiarity with Jira, ServiceNow, or similar ticketing tools.

- Basic scripting knowledge using Python, PowerShell, or Shell scripting is an advantage.

Disclaimer : This job posting has been aggregated from external source. Role detailscontentand availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.

📌 EDI Analyst (Hyderabad)
🏢 Praxis Consultants
📍 Hyderabad