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Independence Blue Cross · 1 month ago

Lead EDI Analyst

Philadelphia, PA

Full-time

Onsite

Senior Level

7+ years exp

Independence Blue Cross is seeking a highly skilled and motivated Lead EDI Analyst to join their EDI Business Operations team. This role is responsible for managing, processing, and optimizing Electronic Data Interchange (EDI) workflows that support payer-side healthcare transactions, driving initiatives to enhance claims processing and ensuring compliance with HIPAA regulations.

Health CareHealth InsuranceInsuranceMedical

H1B Sponsor Likely

Responsibilities

Proactively monitor and analyze production EDI activity to ensure data quality, accuracy, and compliance with mapping specifications, regulatory requirements, industry standards, performance benchmarks, and internal policies

Continuously monitor system health throughout the day to support real-time EDI transactions and minimize disruptions

Work closely with internal stakeholders to support accurate and timely EDI file processing

Engage in cross-functional collaboration with internal business and IT teams, along with external partners and vendors, to resolve issues and guarantee smooth EDI operations

Coordinate with Trading Partners, Account Teams, Providers, and Claims Teams to identify, troubleshoot, and resolve EDI-related issues efficiently

Lead EDI initiatives, including new implementations and system upgrades, ensuring timely execution and alignment with business goals

Facilitate stakeholder engagement throughout the project lifecycle, maintaining clear communication, accountability, and collaboration across internal teams and external partners

Define and document business requirements and mapping specifications for electronic data exchange, ensuring seamless integration between client and internal systems

Participate in requirement review sessions with stakeholders, subject matter experts, and trading partners to validate business needs

Maintain clear documentation and workflows for EDI changes and mapping updates using Microsoft Word, Excel, PowerPoint, and Visio

Collaborate with the Testing Team to design and execute comprehensive test plans and scenarios for defect resolutions, system enhancements, and project initiatives

Support end-to-end testing and validate results through detailed review and approval

Coordinate testing activities with external vendors to ensure alignment, quality, and timely execution of deliverables

Provide support for production checkout and monitor post-implementation defect tracking to ensure stability and performance

Identify and recommend process improvements to enhance operational efficiency and testing effectiveness

Perform additional responsibilities and tasks assigned to support team and organizational goals

Qualification

EDI transaction processingHIPAA EDI standardsEDI tools experienceSQL knowledgeMicrosoft Office proficiencyAnalytical skillsPlanningOrganizingProblem-solving skillsCommunication skills

Required

Bachelor's degree from an accredited institution preferred or equivalent work experience

7+ years of experience in EDI transaction processing, preferably in a healthcare, managed care or insurance environment

Strong knowledge of HIPAA EDI standards (especially 270/271, 276/277, 277CA, 278, 837, 835, 999/TA1)

Experience with EDI tools, translators, and transaction monitoring systems

Excellent analytical, problem-solving, and communication skills

Demonstrated ability in planning, organizing, and executing tasks effectively

Ability to manage multiple priorities in a fast-paced environment

Strong working knowledge of Microsoft Office suite, including: Excel: proficient in creating formulas, using VLOOKUPs, building pivot tables, and performing data analysis; Word, PowerPoint, and Visio: skilled in developing documentation, creating presentations, and mapping business processes

Preferred

Working knowledge of SQL to support defect analysis and resolution

Knowledge of BCBSA Blue Exchange transaction processing

Company

Independence Blue Cross

Glassdoor3.5

The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.

Founded in 1938

Philadelphia, Pennsylvania, USA

5001-10000 employees

https://www.ibx.com

H1B Sponsorship

Independence Blue Cross has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (16)

2024 (2)

2023 (6)

2022 (2)

2021 (6)

2020 (1)