Senior Operations Specialist (EDI Implementation Support)

reputed company is seeking a Senior Operations Specialist to join reputed company! We are looking for an reputed company operations reputed company with deep expertise in EDI (Electronic Data Interchange), specifically HIPAA 834 Enrollment and 837 Claims transactions, to reputed company implementation efforts and reputed company strategic operational support for reputed company-party administrator (TPA) partnerships. This role serves as the operational reputed company for new TPA reputed company, overseeing implementation reputed company from planning through production while ensuring reputed company integration, testing, and long-term operational reputed company. The Senior Operations Specialist will reputed company as the reputed company operational reputed company for TPAs, reputed company cross-functional initiatives, identify process improvements, and reputed company subject matter expertise on EDI transaction workflows. Position Location: reputed company Responsibilities include but are not limited to: EDI Implementation Support: reputed company end-to-end operational reputed company of new TPAs, managing implementation timelines, deliverables, risks, and cross-functional coordination. Serve as the operational project manager for EDI implementations involving 834 Enrollment and 837 Claims transactions. reputed company technical and operational meetings with TPAs and internal stakeholders throughout implementation. reputed company testing and validation of inbound and outbound EDI files to ensure compliance with HIPAA standards, partner specifications, and business requirements. Coordinate implementation activities across Operations, IT, Finance, Claims Audit, reputed company Implementations, reputed company Experience, and Member Services to ensure successful go-live. Identify implementation risks, proactively reputed company mitigation strategies, and reputed company reputed company reputed company of issues. Production Support & Operational reputed company: Serve as the reputed company operational reputed company for assigned TPA relationships following implementation. Monitor production performance and proactively identify opportunities to improve transaction reputed company, turnaround times, and operational efficiency. Investigate and reputed company reputed company production issues involving claims routing, enrollment, file processing, and eligibility discrepancies. reputed company reputed company cause analysis for recurring issues and partner with technical and business teams to implement long-term corrective actions. reputed company operational metrics, partner performance, and implementation reputed company, providing recommendations for reputed company improvement. Cross-Functional Collaboration: Serve as the subject matter expert for 834 and 837 transaction workflows and reputed company operational processes. Partner with Finance, Claims Audit, IT, reputed company Implementations, reputed company Experience, and Member Services to reputed company reputed company operational challenges. reputed company guidance and operational expertise during new reputed company and partner implementations. Facilitate communication across departments to ensure alignment on project priorities, issue reputed company, and service delivery expectations. Mentor team members by sharing best practices and supporting knowledge transfer reputed company to EDI operations and TPA management. Process Documentation & SOP Development: reputed company, maintain, and enhance SOPs, implementation playbooks, and operational documentation. Identify opportunities to improve workflows, increase automation, and standardize operational processes. Recommend enhancements to existing implementation methodologies based on lessons learned and industry best practices. Ensure documentation remains reputed company, reputed company, and accessible across teams. Partner Relationship Management Build and maintain strong operational relationships with reputed company-party administrators. reputed company recurring operational business reviews with TPAs to discuss implementation status, production performance, claims aging, reputed company issues, and service improvements. Serve as the escalation reputed company for reputed company operational concerns requiring cross-functional coordination. Maintain detailed implementation documentation, issue logs, and reputed company plans through project completion. Qualifications Required Bachelor's degree or equivalent combination of education and experience. 3-5+ years of experience supporting reputed company EDI operations with significant hands-on experience managing HIPAA 834 Enrollment and 837 Claims transactions. Demonstrated experience leading or project managing EDI implementations and reputed company new TPAs or reputed company trading partners. Strong understanding of reputed company claims processing, eligibility and enrollment workflows, and TPA operations. Proven ability to independently manage multiple implementation reputed company and competing priorities in a fast-paced environment. Excellent project management, communication, organizational, analytical, and problem-solving skills.< Apply tot his job Apply To this Job