Senior EDI Eligibility Analyst (Remote)

Liviniti; Chicago (IL); Remote; USD 90,000 - 120,000; Full time

Job summary

Liviniti, LLC is seeking an EDI Eligibility Analyst III in Chicago, IL, with REMOTE options. This senior role drives complex eligibility work, ensures data integrity, and acts as escalation and quality backstop for eligibility accuracy.

You will collaborate with EDI, Implementation, Adjudication, and QA teams, test and monitor systems, and support audits while maintaining HIPAA compliance and onboarding new eligibility feeds.

Qualifications

• Bachelor’s degree or equivalent experience.
• 5+ years in eligibility/EDI/healthcare operations.
• PBM or health plan experience strongly preferred.
• Experience supporting production EDI and Eligibility environments.

Responsibilities

• Ensure the quality of eligibility driving claim adjudication.
• Maintain data integrity of upstream eligibility feeds.
• Test, monitor, issue resolution, and escalations.
• Analyze complex eligibility issues impacting claims and member coverage.
• Support audits and internal reviews related to eligibility accuracy.
• Onboard new eligibility feeds with clients and vendors.

Skills

EDI expertise

Analytical skills

Independent worker

Communication skills

Multitasking

Eligibility knowledge

Education

Bachelor’s degree

Tools

270/271 standards

X12 files

ETL tools

SQL & Excel

Relational/No-SQL DBs

Snowflake/AWS/Azure

Zendesk/JIRA/ADO

Job description

Liviniti, LLC is seeking an EDI Eligibility Analyst III in Chicago, IL, with REMOTE options. This senior role drives complex eligibility work, ensures data integrity, and acts as escalation and quality backstop for eligibility accuracy.

You will collaborate with EDI, Implementation, Adjudication, and QA teams, test and monitor systems, and support audits while maintaining HIPAA compliance and onboarding new eligibility feeds.