EDI Analyst

POSITION OVERVIEW

Harbor Health is seeking an EDI Analyst to help build out our EDI operations function, supporting enrollment and claims transactions across our health plan. This is a foundational, hands-on role at a growth-stage payvider: our claims operations are more established, but our EDI function is still being built, and you will play a key role in creating the processes, structure, and automation needed to scale it.

You will work closely with Staphanie, who currently owns this function, to process enrollment files, resolve errors with employer groups and HRIS vendors, and implement new EDI connections as Harbor Health grows. Beyond day-to-day file processing, you will also help test and onboard new trading partner connections, build out documentation and companion guides, monitor file transmission and acknowledgments, and partner with Claims and Benefits & Configuration to make sure enrollment data supports accurate downstream claims and eligibility. This role requires deep, hands-on familiarity with 834 (enrollment) and 837 (claims) EDI files and the ASC X12 standard used for these B2B healthcare transactions.

POSITION DUTIES & RESPONSIBILITIES

EDI File Processing & Enrollment Operations

• Process 834 enrollment files, picking files up from the SFTP and passing them to the appropriate vendor.

• Reconcile log reports received from vendors once enrollment files have been processed.

• Monitor file processing for errors, delays, or exceptions and escalate as needed.

Error Resolution & Stakeholder Communication

• Communicate directly with employer groups and HRIS vendors to identify and correct errors on 834 enrollment files.

• Serve as a key point of contact for enrollment file issues, working to resolve discrepancies quickly and accurately.

Implementation & Process Building

• Implement 834 enrollment file connections for new employer groups.

• Help build and document EDI processes and structure from the ground up, given Harbor Health's EDI function is still being established.

• Identify and help implement opportunities for automation within EDI and enrollment operations.

EDI Testing & Trading Partner Onboarding

• Coordinate testing and certification of new 834 trading partner connections, including test file exchange and sign-off before a new employer group goes live.

• Create and maintain companion guides and file specifications documenting Harbor Health's 834 requirements for each trading partner.

• Conduct user acceptance testing (UAT) on new or modified EDI file feeds prior to production implementation.

Monitoring & Issue Resolution

• Monitor file transmission and processing against expected turnaround times, and escalate missed or delayed files.

• Review functional acknowledgments (e.g., 997/999) and file-level rejections to confirm files were received and processed successfully, and troubleshoot failures.

• Track recurring enrollment error patterns and surface trends to Stephanie and the broader team to inform process or configuration fixes.

Documentation & Governance

• Maintain clear, up-to-date documentation of EDI processes, file specifications, and trading partner configurations as the function matures.

• Apply ASC X12 EDI standards and HIPAA transaction set compliance requirements appropriately across enrollment and claims B2B transactions.

• Maintain deep working knowledge of 834 (enrollment) and 837 (claims) file types, including the specific segments within each.

• Build familiarity with related transaction sets (270, 271, 278, 835) as the EDI function expands.

Cross-Functional & Vendor Coordination

• Serve as a point of contact between Harbor Health and EDI vendors/clearinghouses on file transmission, connectivity, and issue resolution.

• Partner with the Claims and Benefits & Configuration teams to ensure enrollment data flowing through EDI supports accurate downstream claims adjudication and eligibility.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

Required

• 3-5 years of experience working with 834 and 837 EDI files, with a deep understanding of file structure and segments.

• Experience working with the ASC X12 EDI standard used for healthcare B2B transactions, including HIPAA transaction set compliance requirements.

• Experience testing and onboarding new EDI trading partner connections, including companion guide creation/maintenance and UAT prior to go-live.

• Familiarity with functional acknowledgments (e.g., 997/999) and troubleshooting file-level rejections or transmission failures.

• Comfort working in an early-stage/startup environment, building processes, documentation, and structure where none currently exist.

• Strong written and verbal communication skills, with experience coordinating directly with employer groups, HRIS vendors, and/or EDI clearinghouses.

• Comfortable using AI tools (e.g., Claude) and various proprietary systems as part of day-to-day work.

Preferred

• Experience with additional EDI transaction sets: 270, 271, 278, and/or 835

• SQL experience

• Experience with OMNI and/or Snowflake

• Experience with claims administration platforms such as AxisCore, QNXT, Plexis, or similar

• Experience with Individual Family Plan (IFP) enrollment

• Experience working directly with EDI clearinghouses or vendor connectivity teams

WHAT WE OFFER

• Competitive base salary and benefits package

• Comprehensive medical, dental, and vision benefits

• 401(k) with company match

• Generous PTO and paid holidays

• Collaborative and dynamic work environment within an innovative, integrated payvider model

• Professional development and growth opportunities

• A transparent and unique culture focused on member-centered care

COMPANY OVERVIEW

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

EQUAL EMPLOYMENT OPPORTUNITY

Harbor Health is an Equal Opportunity Employer. We celebrate diversity and are committed to building an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.