Analyst, Data Exchange (Medical, Dental & Vision)

Judi Health•Charlotte, NC

2d•Hybrid

About The Position

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between Capital Rx – JUDI Health and its various partners, including employers, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims. The ideal candidate will possess a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data integrity and compliance.

Requirements

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 preferred
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

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
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.