About this opportunity
Simplify Alpha lists this Lead Edifecs Analyst opportunity in northern, Kentucky. Review the employer’s description below for duties, qualifications and application requirements.
Job description
We are looking for a Lead Edifecs Analyst to serve as the primary client-facing technical authority on our large healthcare core administration platform's EDI integration layer. This is a leadership role: you will own solution design and requirements translation directly with client business, compliance, and technical stakeholders, and you will lead and mentor the offshore Edifecs analyst team that builds and supports the day-to-day configurations. Deep, current, hands‑on Edifecs expertise is essential; this is not a purely managerial role, you are expected to personally understand and validate the technical build.
KeyResponsibilities:
Serve as the primaryclient-facing technical lead for Edifecs-based EDI integration across the coreadministration platform (claims, eligibility, enrollment, encounters,remittance)
Own end-to-end design ofEdifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277)
Lead requirements-gathering andsolution-design sessions directly with client business, compliance, andtechnical stakeholders
Translate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live
Provide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance
Own escalation and resolutionof complex production issues across Edifecs EDI flows, coordinating acrossclient, offshore, and platform teams
Partner with architecture andplatform teams to align Edifecs-based integration with the broader coreadministration platform roadmap, including modernization initiatives
Define and enforce standardsfor Edifecs configuration management, version control, testing, and changemanagement
Own status reporting andrisk/issue communication to client stakeholders and program leadership
Drive adoption of AI-assistedengineering practices across the Edifecs analyst team
Required Qualifications:
Bachelor's degree in ComputerScience, Engineering, or a related field
12–15 years of experience inhealthcare EDI/integration engineering, with deep, hands‑on expertise in theEdifecs product suite (e.g., SpecBuilder, XEngine, Transaction/EDI Gateway,Encounter Management)
Strong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components
Strong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms
Deep working knowledge of core HIPAA X12 EDI transactions: 270/271 (eligibility), 834 (enrollment), 835/837(remittance advice/claims), 275 (claim attachment), and 276/277 (claim status inquiry/response)
Proven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment
Experience directly managing client relationships and leading distributed onshore/offshore technical teams
Strong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules)
Excellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders
AI Knowledge & AI‑Assisted Development (Required):
Practical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation
Able to critically review andvalidate AI-generated maps, code, and configurations for correctness andregulatory compliance before deployment
Able to define and enforcestandards for responsible AI tool usage across the team, including strictprohibitions on entering PHI, member data, or other sensitive information intoprompts or external AI tools
Able to identify opportunitieswhere AI-driven automation can improve EDI mapping, testing, or documentationefficiency, and lead adoption across onshore/offshore teams
Comfortable evaluating andchampioning AI-assisted approaches as part of broader platform modernizationinitiatives
Preferred Qualifications:
Direct experience working foror with a health plan/payer organization on core administration systems (e.g.,Facets, QNXT, HealthRules)
CAQH CORE certification orhands-on operating-rule compliance experience
Experience integrating Edifecswith mainframe or cloud-based core administration platforms
Relevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.