EDI Claim Engineer

3 days ago

Bengaluru, India Workforce Next Pvt Ltd. Full time

Profile: EDI Claims Engineer
Experience: 5+ Years
Location: Bengaluru, Karnataka
Job Type: Full-Time

Job Summary:

We are seeking a highly skilled EDI Claims Engineer with a strong background in healthcare claims systems and 5+ years of hands-on experience in EDI (Electronic Data Interchange). The ideal candidate will be responsible for developing, testing, implementing, and maintaining EDI solutions for healthcare claims, with in-depth expertise in formats such as 837, 835, 270/271, and 276/277. This role requires a detail-oriented professional with excellent problem-solving skills and the ability to collaborate across technical and business teams.

Key Responsibilities:

  • Develop, configure, and support EDI integrations for healthcare claims processing.
  • Analyze and troubleshoot issues in EDI transmissions, claim rejections, and mapping errors.
  • Design, create, and maintain EDI maps for formats such as 837 (I/P/D), 835, 270/271, and 276/277.
  • Perform unit, system, and regression testing on EDI transactions.
  • Ensure compliance with HIPAA, CMS, and other healthcare regulatory standards.
  • Collaborate with business analysts, developers, QA teams, and trading partners to meet project deliverables.
  • Monitor daily EDI operations, proactively identify issues, and resolve data discrepancies.
  • Maintain accurate documentation for EDI processes, configurations, and workflows.

Required Skills & Qualifications:

  • 5+ years of experience working with healthcare EDI, specifically 837 and 835 transactions.
  • Hands-on experience with EDI mapping or integration tools (e.g., Edifecs, BizTalk, Optum, or similar).
  • Strong expertise in handling EDI claim rejections and implementing effective resolutions.
  • Experience creating or modifying EDI 837/835 maps using mapping tools.
  • Solid understanding of healthcare standards such as HIPAA and CMS.
  • Practical experience with 270/271 (eligibility) and 276/277 (claim status) transactions.
  • Proficiency in SQL and scripting languages to support EDI workflows.
  • Strong problem-solving and troubleshooting skills in diagnosing complex EDI transmission or mapping issues.

Job Type: Full-time

Pay: ₹1,600, ₹2,400,000.00 per year

Education:

  • Bachelor's (Required)

Experience:

  • EDI: 5 years (Required)
  • SQL: 5 years (Required)
  • Healthcare EDI: 5 years (Required)

Work Location: In person

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