Analyst, Data Exchange Claims Ops (TPA)

Responsibilities

• Design, develop, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 – eligibility and responses, 278 – Prior Auth, 276/277 – claim status, 999/TA1 – file level acknowledgement as well as proprietary formats
• Collaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or third-party administrators) to define data requirements and specifications
• Work with business teams and trading partners to onboard, test and certify new connections and transaction sets
• Develop and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data
• Proactively identify and resolve data discrepancies, errors, and rejections in a timely manner
• Perform root cause analysis for data issues and implement preventative measures
• Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy
• Provide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problems
• Document data exchange processes, configurations, and troubleshooting steps
• Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort
• Stay current with industry best practices, new technologies, and regulatory requirements related to healthcare data exchange
• Generate reports on data exchange performance, error rates, and key metrics
• Analyze data trends to identify potential issues or areas for improvement
• Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Benefits

• Hybrid 3 days a week in-office (NYC, Denver, CO or Charlotte, NC)
• Health benefit administration platform for employers, unions, and plans.
• New York, New York, USA
• https://www.judi.health
• Late Stage
• Total Funding
• $736M
• Key Investors
• General Catalyst,Wellington Management
• Prime Therapeutics
• B Capital
• 2025-09-23
• Series F· $252M
• Secondary Market· $148M
• 2024-03-28
• Series E· $115M
• Leadership Team
• Anthony Loiacono
• CEO & Co-Founder
• John Nicolosi
• Chief Administrative Officer
• Recent News
• MedCity News
• Judi Health Launches Medicare Part D Plan for Employers
• 2026-10-23
• EIN Presswire
• Employers Health and Judi Health Come Together to Offer New Modular PBM Solution: StarkRx
• 2026-09-09
• Judi Health Taps Color Health, WellTheory, Cylinder for Clinical Ecosystem
• 2026-09-04

Qualifications

• * Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a related field. Equivalent work experience may be considered
• * Knowledge of healthcare claim adjudication processes for medical, dental, and vision
• * Strong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS)
• * 2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically within the healthcare industry
• * Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)
• * Excellent analytical, problem-solving, and critical thinking skills
• * Familiarity with various file transfer protocols (FTP, SFTP, FTPS)
• * Understanding of HIPAA compliance and other relevant healthcare regulations
• * Strong attention to detail and a commitment to data accuracy
• * Ability to analyze complex business problems to discover and resolve root causes
• * Proficiency in SQL, Excel, JSON and other technical data skills
• * Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
• * Self-motivated and detail-oriented problem solver
• * Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Required skills

• 834 Enrollment Transactions, 835 Remittance Advice Transactions, 837 Claims Transactions, EDI SNIP Validation, EDIFECS, FTP, FTPS, Healthcare Claim Adjudication, Healthcare EDI, SFTP, SQL

Experience

• 2+ years