EDI Claims Engineer

4 weeks ago

Bengaluru, Karnataka, India Ascendion Full time

Role Overview :

We are seeking a skilled EDI Claims Engineer to join our healthcare technology team. In this role, you will be responsible for designing, implementing, and maintaining Electronic Data Interchange (EDI) systems that support healthcare claims processing. You will ensure seamless data exchange between payers, providers, and clearinghouses, with a strong focus on quality, compliance, and efficiency.

Key Responsibilities :

- Design, develop, and maintain EDI transactions including 837 (claims), 835 (remittance advice), 277 (claim status), 999 (acknowledgment), and other related transaction sets.

- Ensure strict compliance with HIPAA and ANSI X12 standards.

- Collaborate with internal technical teams and external trading partners to troubleshoot, resolve, and prevent EDI transmission issues.

- Monitor and analyze EDI transmissions to identify and perform root cause analysis of failed transactions.

- Support the onboarding of new trading partners, including EDI map configuration and connectivity setup.

- Document detailed workflows, data mappings, and integration processes for internal knowledge sharing and regulatory compliance.

- Continuously improve EDI processes for efficiency, reliability, and scalability.

Preferred Qualifications :

- Strong experience in EDI systems implementation within the U.S. Healthcare domain.

- In-depth understanding of HIPAA compliance, ANSI X12 EDI standards, and healthcare claims processes.

- Hands-on experience with EDI mapping tools and integration platforms.

- Excellent problem-solving and analytical skills.

- Effective communication skills to liaise with cross-functional teams and external partners.

This role offers an exciting opportunity to contribute to healthcare technology solutions that impact patient care and operational efficiency in a fast-growing organization.

(ref:hirist.tech)

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