Position Overview This role will be responsible for supporting the integration of various systems, applications, and data sources to ensure seamless and efficient operations. You will work closely with cross-functional teams to analyze integration requirements, design solutions, and implement integration processes. This role requires strong analytical skills, technical expertise, and the ability to work effectively in a collaborative team environment.
What You’ll Do
Analyze and troubleshoot complex ANSI X12 5010 835 (ERA) transactions, identifying processing, formatting, balancing, and compliance issues.
Perform root cause analysis, resolve EDI processing issues, and implement preventive solutions.
Design and maintain EDI integration workflows, data mappings, technical documentation, and testing plans.
Interpret payer and provider specifications to ensure compliance with HIPAA, ANSI X12, and trading partner requirements.
Generate, validate, and review EDI files, communicating findings and recommendations to internal teams and clients.
Serve as the technical point of contact for escalated 835 remittance, provider payment, and clearinghouse issues.
Partner with internal teams, clients, vendors, and trading partners to resolve integration, connectivity, and workflow challenges.
Leverage AI-enabled tools and automation to improve data quality, validation, reconciliation, and operational efficiency.
Manage multiple priorities, document best practices, ensure HIPAA compliance, and identify process improvement opportunities.
Mentor junior analysts and stay current with healthcare EDI standards, integration technologies, and AI advancements.
What You’ll Bring to Zelis
Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, or a related field, or equivalent experience.
5–7+ years of healthcare EDI experience, including 3–5+ years supporting HIPAA ANSI X12 835 transactions; experience with 837, 834, and 270/271 is a plus.
Strong understanding of the healthcare claims lifecycle, payment processing, provider payment posting, and reconciliation.
Experience with EDI validation tools (Edifecs, Crystal Validation), ANSI X12 standards, data mapping, and healthcare integration processes.
Advanced SQL and data analysis skills; Microsoft SQL Server experience preferred.
Proficiency with Microsoft Teams, Word, Excel, Notepad++, and AI tools such as ChatGPT; Jira, C#, or API experience is a plus.
Excellent analytical, communication, troubleshooting, and problem-solving skills, with the ability to mentor junior analysts and collaborate across technical, operational, and client-facing teams.
Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
Location and Workplace Flexibility
Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.
While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.
- Base Salary Range
- $65,000.00 - $82,650.00
At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.
Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.
