Job Description

Interview : Video Visa : USC, GC, GC EAD, H4 This is hybrid from day-1 ( Local candidates highly preferred ) Description: Job Summary We are seeking a business-focused EDI Business Analyst to serve as a critical link between the business and IT teams. In this role, you'll work directly with operational stakeholders to gather and translate requirements into clear, actionable deliverables. You will support EDI initiatives across multiple functional areas-including claims, provider portals, and customer service portals-to ensure that technical solutions align with real-world business needs. Primary Responsibilities

• Partner with business stakeholders to define, document, and refine requirements for EDI-related projects and enhancements.
• Serve as the liaison between business users and technical teams, translating business needs into functional specifications and user stories.
• Analyze and validate HIPAA EDI transactions (including 837, 835,, 275, etc.) to ensure accuracy, compliance, and alignment with business rules.
• Work across cross-functional areas-not limited to claims, but also provider portal and customer service portal initiatives.
• Participate in testing efforts: create test scenarios, validate EDI data and outputs, and support user acceptance testing (UAT).
• Troubleshoot issues, identify root causes, and recommend corrective actions.
• Ensure deliverables meet project timelines, scope, and quality standards.

• 5+ years of Business Analyst experience within the healthcare payer / health insurance industry.
• Strong understanding of EDI standards, including HIPAAX12 transactions.
• Hands-on experience reviewing and interpreting EDI transaction sets (837, 835,, 275, etc.).
• Working knowledge of FACETS (Facets Claims Processing system).
• Excellent communication, facilitation, and documentation skills with a business-first mindset.
• Experience collaborating across multiple operational domains beyond claims (e.g., provider management, member services, customer service portals).
• Experience working in Agile/Scrum environments is a plus.
• Edifecs experience is a plus.

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