| Required Skills and Experience |
- A strong understanding of payer/provider workflows
- An ability to interpret loops/segmets/element-level errors
- Familiarity with Edifecs Transaction Management or equivalent tools
- Strong experience in Amazon Web Services (AWS) cloud environments
- Excellent communication and stakeholder engagement skills
- A strong understanding of EDI X.12 Loop/segment/element interpretation, SNIP validations (Levels 1-7), companion guide interpretation, and error analysis at segment or element level
- Experience with interpreting Edifecs XEngine validation results and understanding processing rules and transaction profiles
- Experience working with SpecBuilder maps and implementation guides
- An ability to identify issues sourced from Edifecs routes, profiles, or rulesets
- An ability to interpret Edifecs logs and error codes (functional layer, not platform admin level)
- Proficiency with identifying root causes of transaction errors, resolving mapping mismatches, troubleshooting rejections from payers or state systems, and reviewing parsed EDI structures stored in SQL databases
- An ability to understand inbound/outbound workflow architecture
- A strong ability to communicate technical architecture decisions and trade-offs to non-technical stakeholders
- Experience gathering and translating business reporting requirements into technical data models
- Comfort driving ambiguous architecture decisions to resolution with limited direction
- Experience with Agile methodologies (Scrum and Kanban) and JIRA
- Strong documentation habits with creating transaction flow documentation, error trend reports, escalations, and updating Standard Operating Procedures (SOPs) and partner reference guides
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| Professional Certifications | EDIFECS certification |
| Years of Professional Experience | 8+ years of experience of Edifecs product experience in EDI, healthcare, or enterprise application operations
8+ years of EDI/Health Insurance Portability and Accountability Act (HIPAA) |
| Desired experience | Deep hands-on EDIFECS experience in Electronic Data Interchange X.12 (EDI) Transactions Standards involving key X12 workflows involving the following transactions:- X.12 medical claims (837, 834, 835, 276/277, etc)
- 270/271 and 278 transactions
- 820 transactions
- 999/277CA transactions
Knowledge of HIPAA compliance requirements in cloud data architecture
Experience with healthcare payer/PBM systems, clearinghouses, or pharmacy operations
AWS certification in a bonus |
| Formal Education | Bachelor’s degree in Computer Science, Engineering, or a related technical discipline; equivalent practical experience considered |
| Citizenship Requirement | U.S. Citizenship required for this specific opportunity |
| Security Clearance Requirements | Must possess or qualify for a Public Trust (MBI) |
| CRITICAL NOTES: | - SSG will not make assumptions regarding your qualifications. Your answers to the mandatory screening questions must be supported by the information on your resume. Applications with inconsistencies will not be considered.
- Recruiters or Third parties will not be considered.
- This is a 100% U.S. based remote position. However, candidates from CA, CO, IL, MN, NJ, NY, OR, or WA will not be considered.
- This is a W-2 position
- All interviews will be conducted on Microsoft Teams with your camera on; there will be no exceptions
- As part of our screening process, you will be requested to provide a link to your LinkedIn profile
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