EDI Claims Implementation Specialist

ZipStaff Inc.; Chapel Hill (NC); Remote; USD 83.000 - 138.000; Teilzeit

Benefits dieser Stelle

Health Insurance

Dental Insurance

Vision Insurance

401(k) + 401(k) matching

Paid time off

Referral Program

Zusammenfassung

ZipStaff Inc. is seeking an EDI Claims Implementation Specialist to support a Massachusetts Medicaid client through a system migration.

This remote, US-based contract role focuses on inbound claim ingestion, mapping, and pre-adjudication work, bridging claims processing across platforms. You will handle post-adjudication 837 encounter reporting, validation, and reconciliation, and collaborate with cross-functional teams to ensure a smooth cutover while maintaining compliance with Medicaid

Qualifikationen

• 5+ years hands-on EDI claims implementation in healthcare insurance.
• Strong inbound 837 claim ingestion, mapping, validation and routing.
• Post-adjudication 837 encounter reporting experience.
• Recent 4 years in healthcare claims, eligibility and accumulators.
• Authorized to work in the United States without sponsorship.

Aufgaben

• Migrate Massachusetts Medicaid client from one claims system to another.
• Own inbound/pre-adjudication 837 intake, mapping and routing.
• Handle post-adjudication 837 encounter reporting: extraction, submission, and reconciliation.
• Assess impacts to adjudication, eligibility, and accumulators during transition.
• Validate data across platforms and drive defect resolution through cutover.
• Collaborate with functional and technical teams to keep migration on track.

Kenntnisse

EDI claims

Inbound claims

Post-adjudication reporting

System migrations

Healthcare insurance

Jobbeschreibung

Job Title: EDI Claims Implementation Specialist
Location: Remote (U.S.)
Employment Type: Contract (W2 through ZipStaff — No C2C or 1099)

About the Opportunity:

ZipStaff is seeking an EDI Claims Implementation Specialist to support a system migration for a Massachusetts Medicaid client at a major managed care organization.

You will bridge inbound claims, adjudication-system impacts, and downstream encounter reporting as the client moves from one claims platform to another. This is a hands‑on implementation seat focused on healthcare claims — not a general EDI developer role and not a pure outbound reporting role.

What You’ll Do:

• Support migration of a Massachusetts Medicaid client from one claims system to another.
• Own inbound / pre-adjudication work: 837 claim ingestion from providers, including EDI intake, mapping, validation, and routing into the claims platform.
• Support post-adjudication 837 encounter reporting: extraction, mapping, validation, submission, acknowledgments, and reconciliation.
• Assess and address impacts to adjudication, eligibility, and accumulator processing during the transition.
• Validate claims and encounter data across platforms and drive defect resolution through cutover.
• Partner with functional and technical teams to keep the migration on track.

Required Qualifications:

• 5+ years hands-on EDI claims and implementation experience in healthcare insurance.
• Strong inbound claims experience (preferred over outbound) covering 837 claim ingestion, intake, mapping, validation, and routing.
• Post-adjudication experience with 837 encounter reporting, including extraction, mapping, submission, acknowledgments, and reconciliation.
• Recent experience (last 4 years) in healthcare insurance claims, eligibility, and accumulators.
• Proven experience supporting system migrations or implementations where claims processing and encounter reporting moved between platforms.
• Must be legally authorized to work in the United States without sponsorship now or in the future.

Preferred Qualifications:

• MassHealth or Medicaid experience.
• Familiarity with MassHealth 837 encounter reporting requirements.
• Experience with both inbound and outbound claims (team already has some outbound expertise).
• Behavioral health or managed care background.

Benefits:

• Health Insurance.
• Dental Insurance.
• Vision Insurance.
• 401(k) + 401(k) matching.
• Paid time off.
• Referral Program.

About ZipStaff

ZipStaff partners with leading organizations to connect skilled technology professionals with high-impact contract opportunities. We focus on quality matches, clear communication, and long-term success for candidates and clients.