Terms of Employment:
W2 Contract-to-Hire; 6-Months
100% Remote (Must reside in the DMV / local surrounding region for mandatory quarterly in-office meetings);
Schedule: 8:30 AM 5:00 PM EST
Overview:
Work with a leading regional healthcare payer organization assisting in the onboarding and implementation of new commercial accounts. This Functional Analyst will play a key role in managing EDI 834 eligibility file feeds, validating file specifications, conducting rigorous data testing and auditing, and serving as a technical liaison to third-party administrators and vendors to ensure seamless account go-lives ahead of peak renewal seasons.
Key Responsibilities:
Lead the end-to-end onboarding and implementation of new commercial account EDI file feeds (ranging from 50 to 1,000+ member groups).
Analyze, validate, and audit EDI 834 eligibility files to ensure file layouts match specific vendor requirements and match active members in the claims system.
Perform thorough data analysis and end-to-end testing of file feeds prior to promoting data into the production claims environment.
Interface directly with external vendors, third-party administrators (TPAs), and client teams to resolve data discrepancies, clarify specifications, and answer technical questions.
Collaborate with cross-functional teams to ensure smooth account setup during high-volume renewal periods.
Required Qualifications:
Minimum of 4 years of progressive functional/business analysis experience (or 6+ years in a senior operational role; 10 years total operational experience preferred if lacking a bachelor’s degree).
Mandatory hands-on expertise with EDI 834 eligibility file layouts and feed processes.
Direct experience working with the Facets claims platform (Facets G6 or Facets Legacy).
Proven experience in data analysis, data auditing, and testing within a healthcare claims environment.
Strong verbal and written communication skills with experience in vendor-facing or third-party client interaction.
Must reside within the DMV or local commuting region (Southern PA, DE, local WV) and be open to attending quarterly in-office meetings.
Ability to adhere to fixed core working hours of 8:30 AM to 5:00 PM EST.
Preferred Qualifications:
Prior experience utilizing Edifex software for EDI mapping/processing.
Background in Healthcare Business Analysis, Data Analysis, Claims Analysis, or Quality Assurance (QA).
Experience handling commercial book of business implementations.