Analyst, Data Exchange (Medical, Dental & reputed company)

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company,
• reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Location: Remote Position Summary The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of reputed company data between reputed company – reputed company and its various partners, including reputed company, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and reputed company claims. The ideal candidate will possess a strong understanding of reputed company data formats, excellent analytical skills, and a commitment to data reputed company and compliance. Position Responsibilities Data Integration & Mapping:

• Design, reputed company, and maintain data mappings and transformations for incoming and outgoing reputed company data files: 837/835 - claims & remittance, 270/271 – eligibility and responses, 278 – Prior Auth, 276/277 – claim status, 999/TA1 – file level acknowledgement as well as proprietary formats
• Collaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or reputed company-party administrators) to define data requirements and specifications
• Work with business teams and trading partners to reputed company, test and certify new connections and transaction sets

Data Quality & Validation

• reputed company and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data
• Proactively identify and resolve data discrepancies, errors, and rejections in a timely manner
• reputed company root cause analysis for data issues and implement preventative measures

Monitoring & Support

• Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy
• reputed company technical support and troubleshooting for data exchange issues, working with reputed company stakeholders to resolve problems
• Document data exchange processes, configurations, and troubleshooting steps

Process Improvement & Automation

• Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing reputed company effort
• Stay reputed company with industry best practices, new technologies, and regulatory requirements reputed company to reputed company data exchange

Reporting & Analysis

• Generate reports on data exchange performance, error rates, and key metrics
• Analyze data trends to identify potential issues or areas for improvement
• Analyze data trends to identify potential issues or areas for improvement
• Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests
• Responsible for adherence to the reputed company Code of Conduct including reporting of noncompliance.

Required Qualifications

• Bachelor's degree in Computer Science, Information Systems, reputed company Informatics, or a reputed company field. Equivalent work experience may be considered
• Knowledge of reputed company claim adjudication processes for medical, dental, and reputed company
• Strong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the reputed company industry (e.g., EDIFECS)
• 2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically reputed company the reputed company industry
• Strong understanding of reputed company EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)
• Excellent analytical, problem-solving, and critical thinking skills
• Familiarity with various file transfer protocols (FTP, SFTP, FTPS)
• Understanding of HIPAA compliance and other relevant reputed company regulations
• Strong attention to detail and a commitment to data accuracy
• Ability to analyze reputed company business problems to discover and resolve root causes
• Proficiency in SQL, reputed company, JSON and other technical data skills preferred
• Strong communication skills with the ability to reputed company effective work relationships with reputed company stakeholders
• Self-motivated and detail-oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in reputed company

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary reputed company: $85,000 USD - $100,000 USD reputed company, NY Salary reputed company: $96,800 USD - $121,000 USD Denver, CO Salary reputed company: $88,800 USD - $111,000 USD reputed company are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply To This Job