Technical EDI Specialist

🔥 0 minutes ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $72.1k - $94.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Connect for Health Colorado

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

⚕️ Healthcare Insurance

🏪 Marketplace

Healthcare Insurance • Marketplace

Connect for Health Colorado is the official health insurance marketplace for the state of Colorado, offering residents the opportunity to purchase private health insurance plans. The organization operates an open enrollment period from November 1 to January 15, allowing most Coloradans to sign up for health coverage for the following year. Connect for Health Colorado provides a platform to compare healthcare plans, estimate savings, and determine eligibility for financial assistance through Premium Tax Credits. It also offers resources for special enrollment groups, including young adults, Native Americans, and immigrant families, as well as options for small business owners. The marketplace aims to assist consumers in navigating their health insurance options and accessing necessary coverage with potential financial help to lower monthly premiums.

📋 Description

• Serve as the senior subject matter expert for backend EDI transactions, policy services, internal dispute resolution, and regulatory reporting • Act as a key technical partner to Product, Engineering, and Issuer Operations to support enrollment data reconciliation and ensure cross-system alignment between internal systems, issuers, and CMS • Translate production issues, reconciliation discrepancies, and data trends into actionable insights that inform and influence Product prioritization and decision-making • Provide deep analysis of transaction-level issues, data mismatches, and bulk correction impacts to enable accurate problem definition and effective solution design • Support Issuer Operations in resolving reconciliation discrepancies through validation of transaction behavior and cross-system data alignment • Perform advanced SQL analysis to validate eligibility, enrollment, premium, and financial assistance data consistency across systems • Review and validate high-risk and bulk Data Change Requests impacting enrollment, financial assistance, premiums, issuer reconciliation, and regulatory reporting • Validate correction logic against transaction history, eligibility results, policy grouping, and financial assistance calculations to prevent downstream risk • Establish and maintain review standards and governance guardrails to ensure audit readiness, regulatory compliance, and data integrity • Identify systemic patterns and recurring issues, guide root cause analysis, and strengthen data handling and system logic to reduce recurrence • Serve as the technical lead for high-impact production incidents involving enrollment, financial data, issuer data exchange, or reporting discrepancies • Provide mentorship and technical oversight to Production Support team members to strengthen EDI and reconciliation capabilities • Collaborate with BI, Issuer Operations, Architecture, Engineering, and external partners to ensure data integrity and alignment with production behavior • Ensure adherence to Incident and Problem Management processes and contribute to operational maturity within Production Support • Perform other duties as assigned.

🎯 Requirements

• Colorado resident • Bachelor’s degree in computer science, Information Systems, Business Administration, or a directly related field and/or equivalent years of relevant technical experience • Minimum of 5 years of demonstrated experience supporting complex production systems involving EDI transactions, enrollment platforms, or financial data reconciliation • Proficiency in EDI standards (X12), including experience with data mapping and translation concepts • Strong technical knowledge of file formats such as XML and JSON • Experience with communication protocols, including APIs and SFTP • Advanced SQL skills for data analysis, validation, and troubleshooting • Familiarity with tools and platforms such as Java, Swagger, and Rancher • Experience troubleshooting regulatory or external reporting extracts • Experience designing, reviewing, and validating database correction scripts • Experience working within ITIL-based Incident and Problem Management frameworks • Proficiency with tools such as JIRA Service Desk, JIRA Software, Confluence, and production • Exceptional analytical thinking and pattern recognition skills • Ability to operate independently and exercise sound technical judgment in high-impact scenarios • Effective cross-functional collaboration and communication skills • Ability to remain calm and decisive during time-sensitive operational periods, including Open Enrollment.

🏖️ Benefits

• paid time off • short-term and long-term disability • life insurance • 403(b) plan