Analyst, Data Exchange (Medical, Dental & Vision)

About Judi HealthJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, andJudi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.Location: RemotePosition SummaryThe Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx – JUDI Health and its various partners, including employers, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims. The ideal candidate will possess a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data integrity and compliance.Position ResponsibilitiesData Integration & Mapping: Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 – eligibility and responses, 278 – Prior Auth, 276/277 – claim status, 999/TA1 – file level acknowledgement as well as proprietary formatsCollaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or third-party administrators) to define data requirements and specificationsWork with business teams and trading partners to onboard, test and certify new connections and transaction sets Data Quality & ValidationDevelop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged dataProactively identify and resolve data discrepancies, errors, and rejections in a timely mannerPerform root cause analysis for data issues and implement preventative measures Monitoring & SupportProactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracyProvide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problemsDocument data exchange processes, configurations, and troubleshooting steps Process Improvement & AutomationIdentify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort Stay current with industry best practices, new technologies, and regulatory requirements related to healthcare data exchange Reporting & AnalysisGenerate reports on data exchange performance, error rates, and key metricsAnalyze data trends to identify potential issues or areas for improvementAnalyze data trends to identify potential issues or areas for improvementParticipate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.Required QualificationsBachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a related field. Equivalent work experience may be consideredKnowledge of healthcare claim adjudication processes for medical, dental, and visionStrong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS)2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically within the healthcare industryStrong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)Excellent analytical, problem-solving, and critical thinking skillsFamiliarity with various file transfer protocols (FTP, SFTP, FTPS)Understanding of HIPAA compliance and other relevant healthcare regulationsStrong attention to detail and a commitment to data accuracyAbility to analyze complex business problems to discover and resolve root causesProficiency in SQL, Excel, JSON and other technical data skills preferredStrong communication skills with the ability to develop effective work relationships with internal and external stakeholdersSelf-motivated and detail-oriented problem solverAbility to handle multiple competing priorities in a dynamic environment and collaborate in a team This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.Remote, US Salary Range: $85,000 USD - $100,000 USDNew York, NY Salary Range: $96,800 USD - $121,000 USDDenver, CO Salary Range: $88,800 USD - $111,000 USDAll employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.