EDI Enrollment Specialist

IntePros; Philadelphia (Philadelphia County); On-site; USD 65,000 - 90,000; Full time

Job summary

IntePros is seeking an EDI Specialist to support healthcare enrollment operations and inbound EDI enrollment file processing. This role acts as a liaison between clients, trading partners, Account Management, Customer Experience, technical teams, and project stakeholders.

The position requires 2–3+ years in EDI/healthcare enrollment, strong analytical skills, and the ability to collaborate across business and technical teams.

Qualifications

• 2–3+ years of EDI/healthcare enrollment experience.
• Strong understanding of enrollment processing and EDI file workflows.
• Experience with HealthRules and EDI platforms preferred.
• Knowledge of ANSI X12 834, XML, and HIPAA transactions is desirable.
• Experience troubleshooting data, system, and file-processing issues.
• Ability to work across multiple business and technical systems and understand data flows between platforms.
• Strong analytical, problem-solving, documentation, and technical writing skills.
• Excellent communication with clients, stakeholders, and technical teams.

Responsibilities

• Manage and monitor inbound EDI enrollment files, ensuring successful processing and accurate transfer of enrollment data.
• Investigate and resolve file failures, data discrepancies, and integrity issues through troubleshooting and reconciliation.
• Support complex and high-profile EDI clients, including BPO, Shared Services, and non-standard enrollment arrangements.
• Serve as a primary point of contact between EDI senders, clients, business teams, and technical development teams.
• Support EDI enrollment testing, including validation of client-specific files and coordination with Business Systems Analysts.
• Participate in projects involving business requirements, system enhancements, upgrades, sprint activities, testing, and business checkout.
• Manage and support Robotic Process Automation (RPA) initiatives within the business area.
• Support enrollment platforms and workflows, including EDI Portal and HealthRules-related processes.
• Analyze enrollment issues, perform preliminary testing, document findings, and recommend solutions.
• Develop and maintain system documentation, process flows, and desk-level procedures.
• Monitor team inventory and provide training, guidance, and support to Eligibility Specialists.
• Assist with enrollment issue resolution and manual enrollment processing when necessary.
• Maintain departmental quality, accuracy, and productivity standards.

Skills

EDI processing

Healthcare enrollment

Analytical skills

Communication skills

Troubleshooting

Education

Bachelor's degree in Business Administration/MIS/Computer Science or related discipline

Tools

HealthRules

EDI platforms

ANSI X12 834

XML

HIPAA transactions

Job description

EDI Specialist – Healthcare Enrollment

We are seeking an EDI Specialist to support complex healthcare enrollment operations and the successful processing of inbound EDI enrollment files. This role will serve as a key liaison between clients, EDI trading partners, Account Management, Customer Experience, technical teams, and project stakeholders.

Position Summary

We are seeking an EDI Specialist to support complex healthcare enrollment operations and the successful processing of inbound EDI enrollment files. This role will serve as a key liaison between clients, EDI trading partners, Account Management, Customer Experience, technical teams, and project stakeholders.

Key Responsibilities

• Manage and monitor inbound EDI enrollment files, ensuring successful processing and accurate transfer of enrollment data.
• Investigate and resolve file failures, data discrepancies, and integrity issues through troubleshooting and reconciliation.
• Support complex and high-profile EDI clients, including BPO, Shared Services, and non-standard enrollment arrangements.
• Serve as a primary point of contact between EDI senders, clients, business teams, and technical development teams.
• Support EDI enrollment testing, including validation of client-specific files and coordination with Business Systems Analysts.
• Participate in projects involving business requirements, system enhancements, upgrades, sprint activities, testing, and business checkout.
• Manage and support Robotic Process Automation (RPA) initiatives within the business area.
• Support enrollment platforms and workflows, including EDI Portal and HealthRules-related processes.
• Analyze enrollment issues, perform preliminary testing, document findings, and recommend solutions.
• Develop and maintain system documentation, process flows, and desk-level procedures.
• Monitor team inventory and provide training, guidance, and support to Eligibility Specialists.
• Assist with enrollment issue resolution and manual enrollment processing when necessary.
• Maintain departmental quality, accuracy, and productivity standards.

Qualifications

• 2–3+ years of EDI, healthcare eligibility, enrollment, or related experience.
• Strong understanding of healthcare enrollment processing and EDI file workflows.
• Experience with HealthRules and EDI enrollment platforms strongly preferred.
• Knowledge of ANSI X12 834, XML, and HIPAA transactions highly desirable.
• Experience troubleshooting data, system, and file-processing issues.
• Ability to work across multiple business and technical systems and understand how data flows between platforms.
• Strong analytical, problem-solving, documentation, and technical writing skills.
• Excellent communication skills with the ability to collaborate with clients, business stakeholders, and technical teams.
• Proficiency with Microsoft Office and project management/collaboration tools.
• Ability to work independently, manage competing priorities, and take ownership of issues through resolution.
• Bachelor's degree in Business Administration, MIS, Computer Science, or a related discipline preferred; equivalent healthcare/technology experience will be considered.

Ideal Candidate

The strongest candidate will combine healthcare enrollment expertise with technical EDI knowledge. They should be comfortable owning inbound file activity from receipt through resolution, troubleshooting complex enrollment issues, working directly with technical teams, and translating between business, client, and technology stakeholders.