EDI Technical Analyst (Claims)

Location: The position is a Hybrid role at least once a week in Phoenix, AZ 85021

Description:

The EDI Technical Analyst (Claims) is responsible for supporting, analyzing, testing, and maintaining EDI transactions, integrations, and data exchange processes that support healthcare claims operations. This role partners with business and technical teams to troubleshoot production issues, develop technical documentation, create data mappings, support testing efforts, and ensure the successful exchange of healthcare data between trading partners. The ideal candidate combines strong analytical skills, EDI expertise, SQL proficiency, healthcare systems knowledge, and experience supporting payer platforms such as QNXT to drive operational efficiency and data integrity.

What You Will Do:

• Support, troubleshoot, and resolve EDI production issues related to claims and trading partner transactions.
• Analyze, map, and validate healthcare data exchanges including 270/271, 834, 835, and 837 transactions.
• Develop technical specifications, mapping documents, process flows, and operational procedures.
• Write and maintain SQL queries for production support, reporting, testing, and data validation.
• Perform root cause analysis and collaborate with internal teams to resolve data and integration issues.
• Create and execute test plans, process test files, document results, and support defect resolution activities.
• Utilize tools such as Splunk, App Insights, SOAP UI, and Postman to monitor, troubleshoot, and validate system performance.
• Support API integrations, ETL processes, and enterprise data exchange initiatives.
• Develop dashboards, reports, and monitoring solutions to ensure data quality and transaction integrity.
• Participate in project planning, implementation activities, and continuous process improvement initiatives.
• Maintain compliance with HIPAA requirements and healthcare EDI standards including TR3, CAQH CORE, and Blue Exchange guidelines.
• Participate in on-call support rotations and production incident response activities.

You Will Be Successful If:

• You have hands-on experience supporting QNXT, healthcare claims processing, and EDI transaction workflows within a payer environment.
• You have experience supporting healthcare EDI transactions and claims-related data exchanges.
• You can quickly identify, troubleshoot, and resolve complex data and integration issues.
• You possess strong SQL and data analysis skills and can confidently work with large datasets.
• You effectively translate business requirements into technical solutions and documentation.
• You are comfortable working across multiple systems, integrations, and business stakeholders.
• You thrive in a fast-paced environment with competing priorities and deadlines.
• You proactively identify opportunities to improve operational processes, monitoring, and reporting.
• You demonstrate strong communication skills and can explain technical concepts to both technical and non-technical audiences.
• You are committed to delivering high-quality solutions that improve customer and business outcomes.

What You Will Bring:

• High School Diploma or GED required; Bachelor's degree in Computer Science, Information Systems, Business, or related field preferred.
• 2+ years of EDI experience supporting healthcare transactions.
• Experience working with healthcare claims, enrollment, eligibility, or payment transactions (270/271, 834, 835, and 837 preferred).
• Strong experience with QNXT is highly preferred.
• Experience supporting healthcare payer environments, claims processing systems, and trading partner integrations.
• Experience in data analysis, data management, integration, and reporting.
• Strong SQL query development and database analysis skills.
• Knowledge of healthcare EDI standards, HIPAA regulations, and data mapping methodologies.
• Experience with testing tools such as SOAP UI and Postman.
• Familiarity with monitoring and logging tools such as Splunk and App Insights.
• Understanding of API integrations, ETL processes, cloud platforms (AWS, Azure), and enterprise application environments.
• Knowledge of Edifecs EDI platform is a plus.
• Excellent analytical, troubleshooting, technical documentation, and problem-solving skills.
• Ability to manage multiple priorities while working independently and collaboratively across teams.
• Strong communication skills with the ability to translate technical concepts for business and operational stakeholders.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!