EDI Claim Engineer

Profile: EDI Claims Engineer
Experience: 5+ Years
Location: Bengaluru, Karnataka
Job Type: Full-Time

Job Summary:

We are seeking a highly skilled EDI Claims Engineer with a strong background in healthcare claims systems and 5+ years of hands-on experience in EDI (Electronic Data Interchange). The ideal candidate will be responsible for developing, testing, implementing, and maintaining EDI solutions for healthcare claims, with in-depth expertise in formats such as 837, 835, 270/271, and 276/277. This role requires a detail-oriented professional with excellent problem-solving skills and the ability to collaborate across technical and business teams.

Key Responsibilities:

• Develop, configure, and support EDI integrations for healthcare claims processing.
• Analyze and troubleshoot issues in EDI transmissions, claim rejections, and mapping errors.
• Design, create, and maintain EDI maps for formats such as 837 (I/P/D), 835, 270/271, and 276/277.
• Perform unit, system, and regression testing on EDI transactions.
• Ensure compliance with HIPAA, CMS, and other healthcare regulatory standards.
• Collaborate with business analysts, developers, QA teams, and trading partners to meet project deliverables.
• Monitor daily EDI operations, proactively identify issues, and resolve data discrepancies.
• Maintain accurate documentation for EDI processes, configurations, and workflows.

Required Skills & Qualifications:

• 5+ years of experience working with healthcare EDI, specifically 837 and 835 transactions.
• Hands-on experience with EDI mapping or integration tools (e.g., Edifecs, BizTalk, Optum, or similar).
• Strong expertise in handling EDI claim rejections and implementing effective resolutions.
• Experience creating or modifying EDI 837/835 maps using mapping tools.
• Solid understanding of healthcare standards such as HIPAA and CMS.
• Practical experience with 270/271 (eligibility) and 276/277 (claim status) transactions.
• Proficiency in SQL and scripting languages to support EDI workflows.
• Strong problem-solving and troubleshooting skills in diagnosing complex EDI transmission or mapping issues.

Job Type: Full-time

Pay: ₹1,600,000.00 - ₹2,400,000.00 per year

Education:

• Bachelor's (Required)

Experience:

• EDI: 5 years (Required)
• SQL: 5 years (Required)
• Healthcare EDI: 5 years (Required)

Work Location: In person