Data Integration Specialist

The Data Integration Specialist will play a key role in managing and optimizing the flow of health plan enrollment and claims data, ensuring seamless and effective data integration across multiple systems (payroll, PBM, TPA, stop loss, data analytics and health plan solutions). This position is responsible for implementing, testing, monitoring and maintaining data exchanges to ensure accurate and timely data transmission. Additionally, this position will be responsible for production, automation and distribution of plan experience reporting to clients and other partners.

Responsibilities

• Create and maintain processes that manage inbound and outbound claims data, enrollment data and health plan experience reporting
• Implement new vendor data files and manage ongoing files inclusive of eligibility, claims, accumulators and other health plan data exchange needs
• Configure various applications to facilitate consistent and optimal performance related to data exchange leveraging EDI solutions for X12 transactions (e.g., 834, 837).
• Serve as a liaison for internal & external technical staff/business areas to set up data transfer processes.
• Work closely with the development team to build and refine data crosswalks for effective data mapping.
• Coordinate EDI testing and trading partner implementation initiatives.
• Troubleshoot and resolve data transmission issues to ensure the integrity and accuracy of data.
• Respond proactively to service interruptions, work with internal and external stakeholders to communicate status, manage expectations and resolution timelines, mitigate customer impacts, and coordinate the remediation process
• Maintain EDI status tracking, monthly reporting requirements, and detailed documentation of process flows/job aids.
• Facilitate distribution of monthly plan experience reporting to clients, agents and partners.
• Participate on workgroups related to the above responsibilities to provide value to the organization and clients.
• Perform other projects or tasks as required.

Qualifications

• Bachelors degree in Healthcare Administration, Data Management, Mathematics, Statistics Computer Science, Information Technology or a related field (or equivalent work experience).
• 3+ years of experience working inside a TPA, carrier or HMO required.
• Proven experience with EDI mapping tools and transaction validation in the healthcare industry, specifically with X12 standard transaction sets.
• Strong knowledge of EDI translation/communication software and communication protocols, e.g. SFTP.
• Knowledge of HIPAA regulations and a commitment to maintaining compliance with privacy & security standards.
• Excellent communication skills with a strong sense of ownership & commitment to prompt/detailed follow-up.
• Demonstrated ability to work in a dynamic and fast-paced environment managing multiple priorities with pressure of production schedules and deadlines.
• Proven proficiency in the use of Microsoft Office applications. Experience using VBA Software highly desirable.

Job Type: Full-time

Pay: $55,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement

Schedule:

• Monday to Friday

Work Location: Remote

Information :

• Company : TPAC Underwriters
• Position : Data Integration Specialist
• Location : Remote
• Country : US