We are looking for a highly motivated, independent, and organized EDI Lead with strong communication and problem-solving skills to maintain the quality of inbound and outbound Electronic Data Interchange (EDI) files, including ANSI X12, 834 files, flat files, and IEEE formats, through review of each file and any reported discrepancies. The ideal candidate brings a keen eye for detail and a dedication to upholding and enhancing quality standards.
Key Responsibilities:
The essential functions include, but are not limited to, the following:
EDI Quality & File Processing
Monitor all EDI file processing for quality and troubleshoot and resolve all transaction file issues
Monitor, track, and update data required for file transmission. n Consistently maintain standards for monthly quality
Work directly with vendors and carriers on new and changed file requirements, both inbound and outbound, from initiation to implementation
Process Improvement & Documentation
Identify and report issues and opportunities for improvement related to processes and procedures
Develop and maintain documentation related to EDI processes, including reports, metrics, and improvement plans
Own team improvement initiatives and Knowledge Base maintenance
Stay updated on industry standards and regulations related to US healthcare and EDI
Team Support & Collaboration
Assist internal and external teams with any queries regarding file transactions
Assist the EDI team with process questions and escalated issues
Participate in meetings as needed
Support and sustain a positive work environment that fosters team performance through own work and behavior
Perform special tasks and assignments as needed
Requirements
Education & Experience:
Bachelor's/College Degree in any field; an equivalent combination of education and/or experience will be considered
2–3 years of prior experience in quality assurance
2–3 years of prior experience with EDI formats, including mapping new files
1–2 years of experience with SQL
Experience serving international customers. n Working knowledge of HIPAA EDI protocols
3 years of work experience specializing in US health insurance, customer service, or third-party administration, a plus
Familiarity with US healthcare industry standards and regulations related to EDI, a plus
Experience working directly with vendors and carriers on EDI file implementations, a plus
Skills & Competencies:
Detail-oriented with a focus on continuous improvement and problem-solving
Excellent planning and organizational skills, with the ability to effectively manage multiple tasks to completion
Proficient in Microsoft Office (Word, Excel, Teams, Outlook)
Strong interpersonal skills, with the ability to effectively work and collaborate with individuals or groups at all organizational levels; able to work independently and as part of a team
Ability to maintain confidentiality of sensitive information
Minimum of 4 years of experience in the BPO/call center industry
Benefits
Free lunch meal, fruits, snacks, and drinks
Onsite gym with a free professional instructor
Weekly fitness activity and an annual fitness challenge where you can win up to Php 70,000
Weekly engagement activities with prizes that are up to Php 3,000
Free upskilling academy to improve your performance and skillset
State-of-the-art facilities from toilets to your workstation
Amenities such as sleeping quarters, game area, chat room, shower room