[Hiring] EDI Connection Manager @Claim.MD

Role Description

Operating at the intersection of payer relations, enrollment operations, and technical coordination, the EDI Connection Manager serves as a central point of accountability for connection integrity. This role identifies issues affecting payer connectivity, coordinates resolution with internal teams and external partners, maintains visibility into connection performance and readiness, and applies working knowledge of healthcare EDI connectivity methods, electronic transmission technologies, and transaction workflows to support reliable electronic data exchange.

Essential Functions and Responsibilities

• EDI Connection Monitoring & Stability:
  • Monitor, evaluate, and maintain visibility into the operational status and performance of payer EDI connections supporting claims, ERA, eligibility, and related transaction types.
  • Identify disruptions, degradation, or anomalies in payer transmissions and connection workflows.
  • Maintain awareness of scheduled payer changes, outages, or maintenance windows that may impact connectivity.
• Issue Coordination & Resolution:
  • Serve as the primary point-of-contact for connection-related issues, working with internal teams (Payer Relations, Support, Development) to drive timely resolution.
  • Communicate with clearinghouses, payers, or vendors as needed to troubleshoot connection issues and confirm remediation.
  • Track issues through resolution, ensuring documentation and follow-up are completed accurately.
• Operational Oversight & Documentation:
  • Maintain clear, audit-ready documentation of payer connections, connection status, and known issues.
  • Support updates to internal records related to payer connectivity, routing, and transmission readiness.
  • Contribute to process documentation and reference materials related to connection monitoring and escalation paths.
• Change Management & Readiness:
  • Coordinate connection readiness for new payer connections, routing updates, or transmission changes in partnership with Enrollment and Payer Relations teams.
  • Support testing or validation efforts associated with new or modified EDI connections.
  • Identify recurring issues or systemic risks and provide recommendations for operational improvements.
• Technical Coordination & Connectivity:
  • Apply working knowledge of healthcare EDI connectivity methods, including SFTP, APIs, VPNs, secure web services, and other electronic transmission methods used to exchange healthcare transactions.
  • Coordinate technical troubleshooting activities with Development, clearinghouse partners, payers, and vendors to resolve connectivity, transmission, and routing issues.
  • Assist in validating new or modified connection configurations, transmission paths, and connectivity changes before production implementation.
  • Interpret technical information, logs, error messages, or transaction results sufficiently to support issue triage, escalation, and communication with technical stakeholders.
  • Maintain awareness of emerging connectivity standards, payer technical requirements, and industry best practices affecting electronic transaction exchange.
• Cross-Functional Collaboration:
  • Partner with Support to ensure connection-related issues are properly triaged and escalated.
  • Collaborate with Development on technical investigations related to connection stability or transmission errors.
  • Coordinate with Privacy & Compliance to ensure connection monitoring aligns with HIPAA and PHI handling requirements.

Qualifications

• Healthcare EDI Operations Knowledge – Understanding of clearinghouse workflows and payer-provider transaction processes.
• EDI Connection Awareness – Familiarity with how EDI connections support claims, ERA, eligibility, EFT, and related healthcare transactions.
• Healthcare Connectivity Technical Aptitude - Working knowledge of healthcare EDI connectivity methods and technologies (e.g., SFTP, APIs, VPNs, secure web services, certificates, and file transmission protocols) sufficient to coordinate troubleshooting, validate connectivity, and communicate effectively with technical and business stakeholders.
• Operational Monitoring & Coordination – Ability to monitor system health, identify issues, and coordinate resolution across teams.
• Analytical Problem-Solving – Capable of investigating transaction failures, connectivity issues, and operational anomalies; identifying patterns; interpreting technical information; and supporting root-cause analysis across business and technical teams.
• Communication & Stakeholder Coordination – Communicates clearly with internal teams and external partners regarding connection status and issues.
• Documentation & Detail Orientation – Maintains accurate records and clear documentation to support audits and operational continuity.
• Compliance Awareness – Understands the importance of HIPAA, PHI protection, and secure handling of healthcare data.

Requirements

• High school diploma or equivalent required.
• Minimum of 3–5 years of experience in healthcare clearinghouse operations, payer relations, EDI operations, or related roles.
• Experience supporting or coordinating EDI transactions, payer connectivity, or enrollment-related workflows.
• Exposure to healthcare transaction standards (e.g., claims, remittances, eligibility) within a clearinghouse or payer-facing environment.
• Experience working cross-functionally to resolve operational or system-related issues.
• Experience supporting healthcare EDI connectivity using technologies such as SFTP, APIs, VPNs, secure web services, or comparable electronic data exchange methods in a healthcare clearinghouse, payer, vendor, or healthcare technology environment.
• Strong working knowledge of X12 healthcare transaction standards, including 837, 835, 270/271, 276/277, and related implementation guides.

Preferred Skills and Competencies

• Associate’s or Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field preferred or equivalent professional experience.
• Experience with healthcare EDI connectivity using SFTP, REST/SOAP APIs, VPNs, AS2, or secure file transmission technologies.
• Experience interpreting EDI acknowledgements and transaction responses (e.g., 999, 277CA, TA1).
• Experience working with healthcare clearinghouse platforms, payer portals, or electronic transaction monitoring tools.

Benefits

• Compensation Range: $76,000- $86,000 annually, based on experience and geographic location.
• 4-Day (32-hour) Workweek: Full-time, exempt role with a 32-hour weekly schedule.
• Comprehensive Benefits Package: Including health, dental, and vision coverage, as well as retirement savings plan.
• Internet Reimbursement: Up to $100 per month for high-speed internet required for the role.
• Career Growth and Development: Opportunities for skill-building, advancement, and continuous learning.
• Work-Life Balance: Flexible schedules and a supportive, collaborative work environment.
• Inclusive Company Culture: A commitment to diversity, equity, and inclusion in all our practices.
• Employee Wellness: Programs and resources focused on your overall well-being, including mental and physical health support.
• Work Remotely: Opportunity to work remotely in a dedicated work-from-home role.
• Paid-Time Off: Up to ten days of paid time off, in addition to a generous holiday schedule.