Director – EDIFECS Healthcare EDI Core Admin Platform

Simplify Recruiting; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Simplify Recruiting is seeking a Director – EDIFECS to lead the Edifecs-based EDI integration layer for a large healthcare core administration platform. This is a hands-on technology leadership role with direct client engagement and cross-functional coordination.

You will own solution design, translate requirements, review configurations, mentor distributed teams, and ensure regulatory compliance across X12 transactions and AI-assisted development initiatives.

Qualifications

• Bachelor's degree in Computer Science, Engineering, or a related field.
• 15+ years of healthcare EDI/integration experience.
• Deep, current hands-on expertise with the Edifecs product suite (SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management).
• Strong hands-on J2EE experience for customizing Edifecs components.
• Experience with HIPAA X12 transactions and U.S. healthcare payer environments.
• Proven leadership of distributed onshore/offshore teams and client relationships.

Responsibilities

• Serve as the primary client-facing technology leader for Edifecs-based EDI integration across multiple transaction sets.
• Own end-to-end design of Edifecs configurations, transaction maps, and validation rules for X12.
• Lead requirements gathering and solution-design sessions with client stakeholders.
• Translate regulatory and payer requirements into Edifecs specifications and verify builds.
• Review and validate configurations and code prior to production go-live.
• Mentor distributed teams and drive quality, compliance, and delivery excellence.
• Own escalation and resolution of complex production issues across Edifecs EDI flows.
• Drive AI-assisted development practices and ensure regulatory compliance for AI tooling.

Skills

Healthcare payer expertise

Executive-level communication

Client-facing leadership

Solution design & architecture

AI-assisted development awareness

Education

Bachelor's degree in Computer Science or related field

Tools

Edifecs Suite

J2EE customization

MongoDB

PostgreSQL

Oracle

Job description

Core Technology:

Edifecs | X12 EDI | J2EE | MongoDB | PostgreSQL | Oracle | AI-Assisted Development

WHO WILL BE SUCCESSFUL IN THIS ROLE?

We are looking for a senior technology leader who has progressed into Director-level responsibilities without moving away from the technology.

You should bring deep U.S. healthcare payer experience and current, hands-on Edifecs expertise. You must be equally comfortable leading client and executive conversations and getting into the details of Edifecs configurations, X12 transaction flows, integration issues, and technical designs.

This role is best suited for someone who combines three strengths: deep healthcare payer knowledge, hands-on Edifecs expertise, and strong client-facing technology leadership.

ROLE OVERVIEW

We are looking for a Director – EDIFECS to serve as the primary client-facing technology leader for the EDI integration layer of a large healthcare core administration platform.

This is a hands-on technology leadership role, not a purely managerial position. You will own solution design and requirements translation with client business, compliance, and technical stakeholders while providing technical leadership to distributed onshore/offshore Edifecs teams. You will also be expected to personally understand, review, and validate the technical build.

KEY RESPONSIBILITIES

• Serve as the primary client-facing technology leader for Edifecs-based EDI integration across claims, eligibility, enrollment, encounters, and remittance
• Own end-to-end design of Edifecs trading-partner configurations, transaction maps, and validation rules for X12 transactions including 270/271, 834, 835/837, 275, and 276/277
• Lead requirements-gathering and solution-design sessions with client business, compliance, and technical stakeholders
• Translate complex regulatory, payer, and trading-partner requirements into Edifecs technical specifications
• Review and validate completed Edifecs configurations and technical builds before production go-live
• Provide technical leadership and mentorship to distributed Edifecs teams, reviewing designs, code, and configurations for quality and compliance
• Own escalation and resolution of complex production issues across Edifecs EDI flows
• Coordinate across client, offshore, architecture, and platform teams to resolve technical and delivery challenges
• Partner with architecture and platform teams to align Edifecs integration with the broader core administration platform and modernization roadmap
• Define and enforce standards for Edifecs configuration management, version control, testing, and change management
• Mentor Leads and Analysts to drive delivery excellence and technology growth
• Serve as a trusted technology advisor to client stakeholders
• Own status reporting and risk/issue communication to client stakeholders and program leadership
• Drive responsible adoption of AI-assisted engineering practices across the Edifecs team

REQUIRED QUALIFICATIONS

• Bachelor's degree in Computer Science, Engineering, or a related field
• 15+ years of healthcare EDI/integration experience
• Deep, current, hands-on expertise with the Edifecs product suite, including SpecBuilder, XEngine, Transaction/EDI Gateway, and Encounter Management
• Strong hands-on J2EE experience for customizing and extending Edifecs and related integration components
• Strong experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Deep working knowledge of HIPAA X12 transactions:
• 276/277 – Claim Status Inquiry / Response
• Proven experience leading Edifecs implementations end-to-end, from requirements and solution design through production go-live
• Significant experience within a U.S. healthcare payer / health-plan environment
• Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions, including HIPAA and CAQH CORE operating rules
• Experience directly managing client relationships and leading distributed onshore/offshore technical teams
• Strong executive-level verbal and written communication skills, including presenting technical solutions, risks, and recommendations to client and compliance stakeholders

AI KNOWLEDGE & AI-ASSISTED DEVELOPMENT

Practical experience with AI-assisted engineering is required.

The successful candidate should be able to:

• Use AI coding and assistant tools to accelerate Edifecs mapping/transformation development, J2EE customization, testing, and technical documentation
• Critically review and validate AI-generated maps, code, and configurations for technical correctness and regulatory compliance before deployment
• Define and enforce responsible AI usage standards across the team
• Ensure PHI, member information, and other sensitive healthcare data are never entered into unauthorized external AI tools or prompts
• Identify opportunities where AI-driven automation can improve EDI mapping, testing, documentation, and overall engineering efficiency
• Champion appropriate AI-assisted approaches as part of broader platform modernization initiatives

PREFERRED QUALIFICATIONS

• Direct experience working for or with a health plan/payer organization
• Experience with healthcare core administration platforms such as Facets, QNXT, or HealthRules
• CAQH CORE certification or strong hands-on operating-rule compliance experience
• Experience integrating Edifecs with mainframe or cloud-based core administration platforms
• Oracle or PostgreSQL certifications

If your background combines deep healthcare payer expertise, hands-on Edifecs knowledge, and client-facing technology leadership, we would like to hear from you.

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