EDI Analyst

LE013 Zelis Payments, LLC; Missouri; Hybrid; USD 65,000 - 82,650; Full time

Benefits offered by this job

401k match

Flexible paid time off

Holidays and parental leaves

Life and disability insurance

Health benefits

Job summary

Zelis is hiring an experienced EDI Analyst II to support and optimize healthcare EDI integrations, focusing on ANSI X12 ERA transactions. You will troubleshoot complex issues, improve processes with automation, and ensure data accuracy, integrity, and HIPAA compliance.

You will design workflows, mappings, and testing plans, while collaborating with cross-functional teams and external partners. Strong SQL, EDI tools, and AI tool proficiency are required.

Qualifications

• Bachelor’s degree in Information Systems, Healthcare Administration, Computer Science, or related field, or equivalent experience.
• 5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12 transactions; 837, 834, and 270/271 a plus.
• Strong understanding of healthcare claims lifecycle, payment processing, and reconciliation.
• Experience with EDI validation tools (Edifecs, Crystal Validation) and ANSI X12 standards; data mapping and healthcare integration processes.
• Advanced SQL and data analysis skills; MS SQL Server experience preferred.
• Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience a plus.

Responsibilities

• Analyze and troubleshoot ANSI X12 ERA transactions, resolving processing, formatting, balancing, and compliance issues.
• Perform root cause analysis and implement preventive solutions for EDI processing.
• Design and maintain EDI workflows, data mappings, technical docs, and testing plans.
• Interpret payer/provider specs to ensure HIPAA/ANSI X12 compliance.
• Generate, validate, review EDI files and communicate findings to teams and clients.
• Serve as technical contact for escalated 835 remittance and related issues.
• Collaborate with internal teams, clients, vendors to resolve integration challenges.
• Leverage AI-enabled tools to improve data quality, validation, and efficiency.
• Mentor junior analysts and stay current with EDI standards and AI advancements.

Skills

SQL

Data analysis

AI tools

ChatGPT

Problem solving

Education

Bachelor's degree or equivalent

Tools

Edifecs

Crystal Validation

Microsoft SQL Server

Jira

API experience

Job description

Position Overview

As part of our continued growth, Zelis is seeking an experienced EDI AnalystII to support and optimize healthcare EDI integrations with a primary focus on ANSI X125010835 Electronic Remittance Advice (ERA) transactions. In this role you will troubleshoot complex EDI issues, improve integration processes through automation and AI‑enabled tools, and ensure the accuracy, integrity, and compliance of healthcare payment data while collaborating with cross‑functional teams and external partners.

What You’ll Do

• Analyze and troubleshoot complex ANSI X125010835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues.
• Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions.
• Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans.
• Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements.
• Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients.
• Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues.
• Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges.
• Leverage AI‑enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency.
• Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities.
• Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements.

What You’ll Bring

• Bachelor’s degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience.
• 5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12835 transactions; experience with 837, 834, and 270/271 is a plus.
• Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation.
• Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes.
• Advanced SQL and data analysis skills; Microsoft SQL Server experience preferred.
• Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience is a plus.
• Excellent analytical, communication, troubleshooting, and problem‑solving skills, with the ability to mentor junior analysts and collaborate across technical, operational, and client‑facing teams.

Visa sponsorship: Zelis is unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S. with multiple locations across the country and in Hyderabad, India. All employee work locations are based on the needs of the position and are determined by the Leadership team. While location expectations vary by role, candidates within approximately 50miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in‑office presence is guided by team and business needs rather than a fixed weekly schedule.

Compensation

Base Salary Range: $65,000.00 – $82,650.00. The base salary is part of a Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives.

Benefits

• 401k plan with employer match
• Flexible paid time off
• Holidays and parental leaves
• Life and disability insurance
• Health benefits: medical, dental, vision, and prescription drug coverage

Equal Employment Opportunity

Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [e-mail].

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.