EDI Admin I/II

Univera Healthcare; Town of De Witt (NY); On-site; USD 32,000 - 52,000; Full time

Job summary

Univera Healthcare in New York State seeks an EDI Administrator to support onboarding of electronic submissions, testing, and production support. The role involves QA for onboarding, SFTP validation, and resolving issues across FTE teams in a healthcare environment.

Level I–III responsibilities include testing phases, mapping, and coordinating with vendors and clients. The position emphasizes privacy, integrity, and adherence to corporate values in a healthcare setting.

Qualifications

• Two or more years of customer service, electronic transaction support, IT help desk related experience.
• Associates degree in business, information systems, computer science preferred.
• Familiar with GUIs and electronic connectivity systems/applications.
• Understanding of claims routing and file specifications for inbound & outbound transactions.

Responsibilities

• Supports the Business and IT teams with movement of files and automation.
• Loads files manually through SFTP methods for the Business when automation is not available.
• Under guidance, conducts basic testing of electronic submissions.
• Monitors daily electronic transaction processing and takes appropriate action to reduce or eliminate issues.
• Analyzes specific applications to identify, research, and resolve problems.

Skills

Customer service

EDI

SFTP

Testing

Problem solving

Education

Associates degree in business, information systems, or computer science

Tools

GUIs

Electronic connectivity systems

Job description

This job is available in 6 locations Category Customer Service, Claims & Insurance Operations Job Id JR104075 Job Type Full time

Under the direction of assigned management, the Electronic Data Interface (EDI) Administrator is responsible for quality assurance during the onboarding process for all electronic submissions, including testing as well as ongoing production support. This position provides analysis and feedback for continuous process improvement to maximize customer electronic transaction submissions. At the higher levels, the EDI Administrator is responsible for quality assurance of more complex interfaces including Secure File Transfer Protocol (SFTP) facilitation and testing.

Essential Accountabilities:

Level I

• Supports the Business and IT teams with various tasks related to movement of files and automation.


• Loads files manually through SFTP methods for the Business when automation is not available.


• Under guidance, conducts basic testing of electronic submissions.


• Monitors daily electronic transaction processing and takes appropriate action to reduce or eliminate issues. Researches production problems and issues within EDI production Service Level Agreements (SLAs).


• Analyzes specific applications to identify, research, and resolve problems. Documents issues as reported using software to track and monitor. Informs management of problems and potential problems that may impact business.


• Researches web and/or vendor inquiries as required.


• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.


• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.


• Regular and reliable attendance is expected and required.


• Performs other functions as assigned by management.

Level II (in addition to Level I Qualifications)

• Actively participates in all phases of testing for onboard process as well as corporate X12 projects, including regression and Council for Affordable Quality Healthcare testing and onboarding.


• Accountable to understand ANSI X12 transactions, such as 820, 821, 834, 835, 837 996, 997 as well as mapping documentation, Flat File to EDI and EDI to Flat File to be able to implement new file feeds and/or update existing file transactions with vendors, carriers or clients.


• Documents and updates e-commerce procedures within the department.


• Creates flow charts, reports, and training documentation as related to problem solving & projects.


• Assists with Service Requests and project implementation activities.


• Identifies coordination and resolution efforts for trading partners such as dial up and file transfer protocols.

Level III (in addition to Level II Qualifications)

• Conducts certification testing for onboarding of new broker or group formats, mandates, or communications channels.


• Independently translates high level requirements to manipulate and create test data files.


• Delivers & implements work plan on large projects.


• Serves as an escalation analyst for all EDI production related problems with enrollment, gateway defects, web, and/or vendor trouble tickets.


• Assists with testing new vendors or carriers.


• Communicates daily directly with vendors and groups regarding new business rules, onboarding, and testing results of formats or mandates.


• May, at times, represent team management at Senior Level meetings.


• Assists team members in most aspects of e-commerce department.

Minimum Qualifications:

NOTE:

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Two or more years of customer service, electronic transaction support, IT help desk related experience. Associates degree in business, information systems, computer science preferred.


• Demonstrated ability to identify root causes of processing issues and determine sources for solutions and opportunities.


• Familiarity with GUIs and electronic connectivity systems/applications preferred.


• Understanding of claims routing and file specifications for inbound & outbound transaction preferred.


• Strong communication skills (internal, external team), organizational skills, and flexibility meeting demands.


• Familiar with use of PC, Windows, Word, Excel, E-mail.

Level II (in addition to Level I Qualifications)

• A minimum of five years customer service, electronic transaction support, or IT help desk related experience required.


• Experience with GUIs and electronic connectivity systems/applications required.


• Ability to triage and coordinate first level resolution of EDI production issues across departments.

Level III (in addition to Level II Qualifications)

• A minimum of seven years electronic transaction support or IT help desk related experience required.


• At least one year experience of independent EDI production issue resolution required.
  
• Expertise with GUIs and electronic connectivity systems/applications required.


• Ability to analyze claims routing and file specifications for inbound and outbound transactions required.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.


• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Equal Opportunity Employer

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Compensation Range(s):

Level I (N7): Minimum: $23.75/hr - Maximum: $37.70/hr

Level II (N8): Minimum: $26.90/hr - Maximum: $43.02/hr

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

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JobId JR104075

type Full time