Manager, EDI Customer Operations

Bcbsla; Baton Rouge (LA); On-site; USD 120,000 - 150,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana is seeking a senior leader to direct the EDI Customer Operations team, overseeing provider connectivity solutions, clearinghouse operations, and provider-facing digital platforms. You will drive performance, compliance, and continuous improvement across daily transaction processing and customer support.

The role requires strong leadership, HIPAA/EDI expertise, and collaboration with cross-functional teams to ensure secure, timely data exchange and service

Qualifications

• Bachelor’s degree in Computer Science, Information Systems, Business Administration, Healthcare Administration, or a related field.
• Four years of directly related experience may be substituted for a degree.
• 5 years of experience in healthcare operations, EDI, provider connectivity, systems operations, healthcare technology, or a related field.
• 2 years of leadership experience.
• Advanced knowledge of HIPAA Transactions and Code Sets, healthcare EDI standards, and electronic healthcare transaction processing.
• Strong understanding of healthcare claims, clearinghouse operations, provider connectivity, and related business processes.
• Demonstrated ability to lead operational, technology, and process improvement initiatives.
• Proven analytical, critical-thinking, and problem-solving skills.

Responsibilities

• Provides leadership, direction, and development for staff responsible for EDI operations, provider connectivity, systems support, implementation activities, and customer support services.
• Oversees the organization’s electronic transaction ecosystem and provider-facing digital services, ensuring system reliability and compliant data exchange.
• Ensures compliance with HIPAA, CMS, and state/federal regulatory requirements governing electronic transactions and data exchange.
• Leads operational support, incident management, root-cause analysis, process improvement, automation, and technology enhancement initiatives.
• Monitors operational performance through metrics, reporting, forecasting, and trend analysis.
• Manages strategic planning, budgeting, resource allocation, vendor relationships, and priorities to support business needs.

Skills

EDI Operations

Team leadership

HIPAA knowledge

Provider connectivity

Project management

Analytical thinking

Cross-functional collaboration

Education

Bachelor’s degree in Computer Science, Information Systems, Business Administration, Healthcare Administration, or a related field

Job description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.

Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

POSITION PURPOSE

Provides leadership and oversight for the EDI Customer Operations team, directing EDI services, provider connectivity solutions, clearinghouse operations, and provider-facing digital platforms. Oversees daily operations, including transaction processing, systems support, issue resolution, testing, implementations, customer and provider support, reporting, vendor management, and project execution to ensure the accurate, timely and secure exchange of healthcare information. Leads initiatives to enhance operational performance, customer experience, automation, compliance, and service delivery while developing staff and fostering a culture of accountability, collaboration, innovation, and continuous improvement.

How You Contribute to the Company’s Mission in This Role

Provides leadership, direction, and development for staff responsible for EDI operations, provider connectivity, systems support, implementation activities, and customer support services.

Oversees the organization’s electronic transaction ecosystem and provider-facing digital services, ensuring system reliability and the accurate, timely, secure, and compliant exchange of healthcare transactions and information.

Ensures compliance with applicable HIPAA, CMS, Blue Cross and Blue Shield Association, state, federal, and other regulatory requirements governing electronic transactions, provider connectivity, data exchange, and related operational processes.

Leads operational support, incident management, root-cause analysis, process improvement, automation, and technology enhancement initiatives to improve efficiency, scalability, accuracy, service delivery, and customer satisfaction.

Monitors operational performance through metrics, reporting, forecasting, and trend analysis.

Manages strategic planning, budgeting, resource allocation, vendor relationships, and operational priorities to support current and future business needs.

Partners with leaders, business areas, technology teams, healthcare providers, clearinghouses, vendors, government agencies, regulatory bodies, and other external parties to establish priorities, resolve issues, coordinate system enhancements, and implement enterprise projects and regulatory changes.

Required Qualifications

• Bachelor’s degree in Computer Science, Information Systems, Business Administration, Healthcare Administration, or a related field.
• Four years of directly related experience may be substituted for a degree.
• 5 years of experience in healthcare operations, EDI, provider connectivity, systems operations, healthcare technology, or a related field.
• 2 years of leadership experience.
• Advanced knowledge of HIPAA Transactions and Code Sets, healthcare EDI standards, and electronic healthcare transaction processing.
• Strong understanding of healthcare claims, clearinghouse operations, provider connectivity, and related business processes.
• Demonstrated ability to lead operational, technology, and process improvement initiatives, including project delivery, change management, automation, and continuous improvement efforts.
• Proven analytical, critical-thinking, and problem-solving skills, including the ability to diagnose complex business and technical issues and implement effective solutions.
• Strong leadership, communication, organizational, and interpersonal skills, with the ability to build partnerships, influence stakeholders, and lead cross-functional teams.
• Ability to interpret technical documentation, operational metrics, and business requirements to drive informed decision-making and operational excellence.
• Commitment to delivering exceptional customer and provider experiences while managing competing priorities in a dynamic environment.

Preferred Qualifications

• Project management, process improvement, or operational transformation experience.

Additional Accountabilities and Essential Functions

Additional physical demands and duties: job duties are performed in a normal and clean office environment with normal noise levels. Work is predominantly performed while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze is required.

An Equal Opportunity Employer. All applicants are encouraged to apply.

Company Mission: To improve the health and lives of Louisianians.

Company Vision: A better state of health through preventative, easier and more affordable healthcare.

Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity company and is an independent licensee of the Blue Cross Blue Shield Association.

Blue Cross and Blue Shield of Louisiana is licensed to sell products only in the state of Louisiana.

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.