Job Descriptions

Edifecs · Healthcare EDI · Core Administration Platform

Roles: Lead Edifecs Analyst (Onsite, 12–15 years) and Senior Edifecs Analyst (Offshore – Hyderabad, 8–12 years)

Lead Edifecs Analyst – Healthcare EDI & Core Admin Platform (Onsite)

Location: Onsite – United States

Experience: 12–15 years

Tech Stack: Edifecs (Spec Builder, XEngine, Transaction/EDI Gateway, Encounter Management), J2 EE, Mongo DB, Postgre SQL, Oracle, X12 EDI (270/271, 834, 835/837, 275, 276/277), AI-Assisted Development

Role Overview

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.

Key Responsibilities

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

Required Qualifications

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., Spec Builder, XEngine, Transaction/EDI Gateway, Encounter Management)

Solid, hands-on expertise in J2 EE for customizing and extending Edifecs and related integration components

Strong, hands-on experience with Mongo DB, Postgre SQL, 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, J2 EE 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, Health Rules)

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 Postgre SQL DBA certifications

📌 Lead Edifecs Analyst (Hyderabad)
🏢 Simplify AlphaTM
📍 Hyderabad