Technical EDI Specialist

This is a fully remote position, open to applicants in Colorado.

📋 Description

• Act as the leading subject matter expert for backend EDI transactions, policy services, internal dispute resolution, and regulatory reporting.

• Function as a critical technical collaborator with Product, Engineering, and Issuer Operations to facilitate enrollment data reconciliation and ensure alignment across internal systems, issuers, and CMS.

• Convert production challenges, reconciliation inconsistencies, and data trends into actionable insights that guide Product prioritization and decision-making.

• Conduct in-depth analysis of transaction-level issues, data mismatches, and the effects of bulk corrections to enable precise problem identification and effective solution design.

• Assist Issuer Operations in resolving reconciliation inconsistencies through the validation of transaction behavior and cross-system data alignment.

• Execute advanced SQL analysis to confirm eligibility, enrollment, premium, and financial assistance data consistency across systems.

• Review and validate high-risk and bulk Data Change Requests that impact enrollment, financial assistance, premiums, issuer reconciliation, and regulatory reporting.

• Validate correction logic against transaction history, eligibility outcomes, policy categorization, and financial assistance calculations to mitigate downstream risk.

• Establish and uphold review standards and governance guidelines to ensure audit readiness, regulatory compliance, and data integrity.

• Identify systemic patterns and recurring issues, guide root cause analysis, and enhance data handling and system logic to minimize recurrence.

• Serve as the technical lead for significant production incidents relating to enrollment, financial data, issuer data exchange, or reporting discrepancies.

• Provide mentorship and technical guidance to Production Support team members to enhance EDI and reconciliation expertise.

• Collaborate with BI, Issuer Operations, Architecture, Engineering, and external partners to ensure data integrity and consistency with production behavior.

• Ensure compliance with Incident and Problem Management processes and contribute to the operational maturity of Production Support.

• Perform additional duties as required.

⛳️ Requirements

• Must be a resident of Colorado.

• Bachelor's degree in computer science, Information Systems, Business Administration, or a closely related field, along with equivalent years of relevant technical experience.

• At least 5 years of proven experience in supporting complex production systems involving EDI transactions, enrollment platforms, or financial data reconciliation.

• Proficient in EDI standards (X12), with experience in data mapping and translation concepts.

• Strong technical expertise in file formats such as XML and JSON.

• Familiarity with communication protocols, including APIs and SFTP.

• Advanced SQL skills for data analysis, validation, and troubleshooting.

• Knowledge of tools and platforms like Java, Swagger, and Rancher.

• Experience in troubleshooting regulatory or external reporting extracts.

• Experience in designing, reviewing, and validating database correction scripts.

• Experience working within ITIL-based Incident and Problem Management frameworks.

• Proficient in tools such as JIRA Service Desk, JIRA Software, Confluence, and production.

• Outstanding analytical thinking and pattern recognition skills.

• Ability to work independently and exercise sound technical judgment in high-impact situations.

• Strong cross-functional collaboration and communication skills.

• Ability to stay calm and make decisive choices during time-sensitive operational periods, including Open Enrollment.

🏝️ Benefits

• Paid time off.

• Short-term and long-term disability.

• Life insurance.

• 403(b) plan.