Lead Edifecs Analyst

Simplify Alpha; United States; On-site; USD 170,000 - 210,000; Full time

Job summary

Simplify Alpha seeks a Lead Edifecs Analyst to act as the primary client-facing technical authority on our healthcare core administration platform's EDI integration layer. You will own solution design, translate requirements with client stakeholders, and mentor an offshore Edifecs analyst team, while personally validating Edifecs builds.

You will guide end-to-end Edifecs configurations, maps, and validation rules for 270/271, 834, 835/837, and more, ensuring regulatory compliance before go-live.

Qualifications

• Bachelor's degree in CS/Engineering or related field.
• 12–15 years in healthcare EDI/integration with hands-on Edifecs expertise.
• Strong J2EE customization experience for Edifecs components.
• Extensive knowledge of X12 transactions (270/271, 834, 835/837, 275, 276/277).
• Experience leading Edifecs implementations end-to-end in health plans.

Responsibilities

• Serve as primary client-facing Edifecs technical lead for EDI integration.
• Own end‑to‑end Edifecs design, configurations, and validation rules.
• Lead requirements gathering with business, compliance, and tech.
• Translate regulatory needs into Edifecs specifications and validate builds.
• Provide technical leadership to offshore Edifecs analysts.
• Own incident escalation and resolution across Edifecs flows.
• Coordinate with architecture to align with platform roadmap.
• Define standards for configuration management and testing.
• Report status and risks to stakeholders and leadership.
• Drive AI-assisted engineering practices across the team.

Skills

Edifecs expert

EDI/X12 knowledge

J2EE development

Database proficiency

AI-assisted development

Leadership/mentoring

Requirements translation

Regulatory compliance

Production issue resolution

Education

Bachelor's in CS/Engineering or related

Tools

Edifecs SpecBuilder

Edifecs XEngine

Edifecs Transaction/EDI Gateway

Edifecs Encounter Management

MongoDB

PostgreSQL

Oracle

Job description

We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform's EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations. Deep, current, hands-on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build.

Key Responsibilities

• Serve as the primary client-facing technical lead for Edifecs-based EDI integration across the core administration platform (claims, eligibility, enrollment, encounters, remittance)
• Own end-to-end design of Edifecs trading partner configurations, transaction maps, and validation rules for X12 transactions (270/271, 834, 835/837, 275, 276/277)
• Lead requirements-gathering and solution-design sessions directly with client business, compliance, and technical stakeholders
• Translate complex regulatory, payer, and trading-partner requirements into Edifecs specifications, and validate that the completed build meets those requirements before go-live
• Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance
• Own escalation and resolution of complex production issues across Edifecs EDI flows, coordinating across client, offshore, and platform teams
• Partner with architecture and platform teams to align Edifecs-based integration with the broader core administration platform roadmap, including modernization initiatives
• Define and enforce standards for Edifecs configuration management, version control, testing, and change management
• Own status reporting and risk/issue communication to client stakeholders and program leadership
• Drive adoption of AI-assisted engineering practices across the Edifecs analyst team

Required Qualifications

• Bachelor's degree in Computer Science, Engineering, or a related field
• 12–15 years of experience in healthcare EDI/integration engineering, with deep, hands‑on expertise in the Edifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway, Encounter Management)
• Strong, hands‑on expertise in J2EE for customizing and extending Edifecs and related integration components
• Strong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
• Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837 (remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response)
• Proven experience leading Edifecs implementations end‑to‑end, from requirements through go‑live, in a health plan/payer core administration environment

AI Knowledge & AI‑Assisted Development (Required)

• Practical, daily use of AI coding/assistant tools to accelerate Edifecs map/transformation development, J2EE customization, and technical documentation
• Able to critically review and validate AI-generated maps, code, and configurations for correctness and regulatory compliance before deployment
• Able to define and enforce standards for responsible AI tool usage across the team, including strict prohibitions on entering PHI, member data, or other sensitive information into prompts or external AI tools
• Able to identify opportunities where AI‑driven automation can improve EDI mapping, testing, or documentation efficiency, and lead adoption across onshore/offshore teams
• Comfortable evaluating and championing AI‑assisted approaches as part of broader platform modernization initiatives

Preferred Qualifications

• Direct experience working for or with a health plan/payer organization on core administration systems (e.g., Facets, QNXT, HealthRules)
• CAQH CORE certification or hands‑on operating‑rule compliance experience
• Experience integrating Edifecs with mainframe or cloud‑based core administration platforms
• Relevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications