Business Analyst – Eligibility (EDI)

ZipStaff•Boston, MA

7d•Remote

About The Position

ZipStaff is seeking an experienced Business Analyst specializing in Electronic Data Interchange (EDI) to support a leading healthcare organization. The role focuses on implementing 834 and proprietary eligibility, coordination of benefits (COB), and group files for health plans. The analyst will lead the design and implementation of end-to-end eligibility-exchange frameworks, facilitate stakeholder discussions, create comprehensive documentation, and conduct end-to-end testing. The assignment is a short-term contract through December 31, 2026, supporting a pre-identified vendor-to-W2 conversion opportunity. Work is primarily remote, with a Boston, Massachusetts base worksite and possible on-site work in Washington, DC if required.

Requirements

Bachelor’s degree.
Expertise in Electronic Data Interchange (EDI).
Experience implementing 834 and proprietary eligibility, COB, and group files for health plans.
Strong experience developing and performing test scenarios for end-to-end testing.
Ability to work independently, facilitate stakeholder discussions, and produce clear documentation.
Ability to work primarily remotely, with a Boston, MA base worksite.
Pure research or junior experience will not be considered.

Nice To Haves

Prior experience supporting eligibility exchanges or related EDI processes in a healthcare payer environment.
Hands-on experience with health plan eligibility, COB, and group file implementations.
Track record of leading requirements discussions and UAT reviews with health plan stakeholders.
Experience producing process flows, business rules documentation, and technical specifications for EDI frameworks.

Responsibilities

Independently develop a comprehensive understanding of business rules, core platforms, applications, and data used in EDI exchanges.
Lead the design and implementation of end-to-end frameworks for processing eligibility exchanges that meet business needs and industry standards.
Facilitate discussions with health plans and other stakeholders to identify and clarify requirements.
Review UAT test cases and ensure alignment on project objectives and deliverables.
Develop documentation covering business rules, process flows, and technical specifications.
Develop test scenarios and conduct multiple rounds of end-to-end testing.
Work independently and with minimal oversight.