{"schemaVersion":"jobsearcher.job.v1","id":"d5cfef951e46d020e5f2c8f2","url":"https://jobsearcher.com/jobs/d5cfef951e46d020e5f2c8f2","canonicalUrl":"https://jobsearcher.com/jobs/d5cfef951e46d020e5f2c8f2","title":"Lead Edifecs Analyst","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.\n\nKeyResponsibilities:\n\nServe as the primaryclient-facing technical lead for Edifecs-based EDI integration across the coreadministration platform (claims, eligibility, enrollment, encounters,remittance)\n\nOwn end-to-end design ofEdifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277)\n\nLead requirements-gathering andsolution-design sessions directly with client business, compliance, andtechnical stakeholders\n\nTranslate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live\n\nProvide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance\n\nOwn escalation and resolutionof complex production issues across Edifecs EDI flows, coordinating acrossclient, offshore, and platform teams\n\nPartner with architecture andplatform teams to align Edifecs-based integration with the broader coreadministration platform roadmap, including modernization initiatives\n\nDefine and enforce standardsfor Edifecs configuration management, version control, testing, and changemanagement\n\nOwn status reporting andrisk/issue communication to client stakeholders and program leadership\n\nDrive adoption of AI-assistedengineering practices across the Edifecs analyst team\n\nRequired Qualifications:\n\nBachelor's degree in ComputerScience, Engineering, or a related field\n\n12–15 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)\n\nStrong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components\n\nStrong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms\n\nDeep 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)\n\nProven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment\n\nExperience directly managing client relationships and leading distributed onshore/offshore technical teams\n\nStrong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules)\n\nExcellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders\n\nAI Knowledge & AI‑Assisted Development (Required):\n\nPractical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation\n\nAble to critically review andvalidate AI-generated maps, code, and configurations for correctness andregulatory compliance before deployment\n\nAble 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\n\nAble to identify opportunitieswhere AI-driven automation can improve EDI mapping, testing, or documentationefficiency, and lead adoption across onshore/offshore teams\n\nComfortable evaluating andchampioning AI-assisted approaches as part of broader platform modernizationinitiatives\n\nPreferred Qualifications:\n\nDirect experience working foror with a health plan/payer organization on core administration systems (e.g.,Facets, QNXT, HealthRules)\n\nCAQH CORE certification orhands-on operating-rule compliance experience\n\nExperience integrating Edifecswith mainframe or cloud-based core administration platforms\n\nRelevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications\n\nYou can always press Enter to continue\n\n#J-18808-Ljbffr","company":"Simplify Alpha","rawCompany":"simplify alpha","city":"Brooklyn","state":"NY","isRemote":false,"isActive":false,"createdAt":"2026-09-21T03:17:01.002Z","occupations":[{"code":"15-1211.01","title":"Health Informatics Specialists","slug":"health-informatics-specialists"},{"code":"15-1211.00","title":"Computer Systems Analysts","slug":"computer-systems-analysts"},{"code":"15-1252.00","title":"Software Developers","slug":"software-developers"}],"industries":[{"code":"541512","title":"Computer Systems Design Services","slug":"computer-systems-design-services"},{"code":"541511","title":"Custom Computer Programming Services","slug":"custom-computer-programming-services"},{"code":"513210","title":"Software Publishers","slug":"software-publishers"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Lead Edifecs Analyst","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.\n\nKeyResponsibilities:\n\nServe as the primaryclient-facing technical lead for Edifecs-based EDI integration across the coreadministration platform (claims, eligibility, enrollment, encounters,remittance)\n\nOwn end-to-end design ofEdifecs trading partner configurations, transaction maps, and validation rulesfor X12 transactions (270/271, 834, 835/837, 275, 276/277)\n\nLead requirements-gathering andsolution-design sessions directly with client business, compliance, andtechnical stakeholders\n\nTranslate complex regulatory,payer, and trading-partner requirements into Edifecs specifications, andvalidate that the completed build meets those requirements before go-live\n\nProvide technical leadership and mentorship to the offshore Edifecs analyst team, reviewing designs, code, and configurations for quality and compliance\n\nOwn escalation and resolutionof complex production issues across Edifecs EDI flows, coordinating acrossclient, offshore, and platform teams\n\nPartner with architecture andplatform teams to align Edifecs-based integration with the broader coreadministration platform roadmap, including modernization initiatives\n\nDefine and enforce standardsfor Edifecs configuration management, version control, testing, and changemanagement\n\nOwn status reporting andrisk/issue communication to client stakeholders and program leadership\n\nDrive adoption of AI-assistedengineering practices across the Edifecs analyst team\n\nRequired Qualifications:\n\nBachelor's degree in ComputerScience, Engineering, or a related field\n\n12–15 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)\n\nStrong, hands‑on expertise inJ2EE for customizing and extending Edifecs and related integration components\n\nStrong, hands‑on experience with MongoDB, PostgreSQL, and Oracle databases supporting EDI/integration platforms\n\nDeep 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)\n\nProven experience leading Edifecs implementations end-to-end, from requirements through go-live, in a health plan/payer core administration environment\n\nExperience directly managing client relationships and leading distributed onshore/offshore technical teams\n\nStrong understanding of healthcare compliance and regulatory requirements affecting EDI transactions(HIPAA, CAQH CORE operating rules)\n\nExcellent verbal and written communication skills, including experience presenting to client executives and compliance stakeholders\n\nAI Knowledge & AI‑Assisted Development (Required):\n\nPractical, daily use of AIcoding/assistant tools to accelerate Edifecs map/transformation development,J2EE customization, and technical documentation\n\nAble to critically review andvalidate AI-generated maps, code, and configurations for correctness andregulatory compliance before deployment\n\nAble 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\n\nAble to identify opportunitieswhere AI-driven automation can improve EDI mapping, testing, or documentationefficiency, and lead adoption across onshore/offshore teams\n\nComfortable evaluating andchampioning AI-assisted approaches as part of broader platform modernizationinitiatives\n\nPreferred Qualifications:\n\nDirect experience working foror with a health plan/payer organization on core administration systems (e.g.,Facets, QNXT, HealthRules)\n\nCAQH CORE certification orhands-on operating-rule compliance experience\n\nExperience integrating Edifecswith mainframe or cloud-based core administration platforms\n\nRelevant certifications: Edifecs product certifications, Oracle or PostgreSQL DBA certifications\n\nYou can always press Enter to continue\n\n#J-18808-Ljbffr","datePosted":"2026-09-21T03:17:01.002Z","dateModified":"2026-09-21T03:17:01.002Z","hiringOrganization":{"@type":"Organization","name":"Simplify Alpha","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Brooklyn","addressRegion":"NY","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"d5cfef951e46d020e5f2c8f2"},"url":"https://jobsearcher.com/jobs/d5cfef951e46d020e5f2c8f2"}}