Manager, EDI Customer Operations

Blue Cross and Blue Shield of Louisiana • Baton Rouge, LA

5d

About The Position

Provides leadership and oversight for the EDI Customer Operations team, directing EDI services, provider connectivity solutions, clearinghouse operations, and provider-facing digital platforms. Oversees daily operations such as transaction processing, systems support, issue resolution, testing, implementations, customer and provider support, reporting, vendor management, and project execution. The role ensures the accurate, timely, and secure exchange of healthcare information and leads initiatives to improve operational performance, customer experience, automation, compliance, and service delivery. It also develops staff and fosters accountability, collaboration, innovation, and continuous improvement.

The position leads staff responsible for EDI operations, provider connectivity, systems support, implementations, and customer support. It oversees electronic transactions and provider-facing digital services, ensuring reliability and compliance with applicable HIPAA, CMS, Blue Cross and Blue Shield Association, state, federal, and other regulatory requirements. The manager leads operational support, incident management, root-cause analysis, process improvement, automation, and technology enhancements; monitors performance through metrics, reporting, forecasting, and trend analysis; and manages strategic planning, budgeting, resource allocation, vendor relationships, and operational priorities. The role partners with internal and external stakeholders to set priorities, resolve issues, coordinate enhancements, and implement enterprise projects and regulatory changes.

The job is performed in a normal, clean office environment with normal noise levels. Work is predominantly performed while standing or sitting. Residency in or relocation to Louisiana is preferred. Applicants must be authorized to work in the United States without employer-sponsored immigration support.

Requirements

• Bachelor’s degree in Computer Science, Information Systems, Business Administration, Healthcare Administration, or a related field; four years of directly related experience may be substituted for a degree.
• Five years of experience in healthcare operations, EDI, provider connectivity, systems operations, healthcare technology, or a related field.
• Two years of leadership experience.
• Advanced knowledge of HIPAA Transactions and Code Sets, healthcare EDI standards, and electronic healthcare transaction processing.
• Strong understanding of healthcare claims, clearinghouse operations, provider connectivity, and related business processes.
• Demonstrated ability to lead operational, technology, and process improvement initiatives, including project delivery, change management, automation, and continuous improvement.
• Proven analytical, critical-thinking, and problem-solving skills, including diagnosing complex business and technical issues and implementing effective solutions.
• Strong leadership, communication, organizational, and interpersonal skills, including the ability to build partnerships, influence stakeholders, and lead cross-functional teams.
• Ability to interpret technical documentation, operational metrics, and business requirements to support informed decision-making and operational excellence.
• Commitment to delivering exceptional customer and provider experiences while managing competing priorities in a dynamic environment.
• Must be authorized to work in the United States without employer-sponsored immigration or other immigration support.

Nice To Haves

• Project management, process improvement, or operational transformation experience.
• Residency in or relocation to Louisiana is preferred.

Responsibilities

• Provide leadership, direction, and development for staff responsible for EDI operations, provider connectivity, systems support, implementation activities, and customer support services.
• Oversee electronic transaction operations and provider-facing digital services, ensuring system reliability and accurate, timely, secure, and compliant exchange of healthcare transactions and information.
• Ensure compliance with applicable HIPAA, CMS, Blue Cross and Blue Shield Association, state, federal, and other regulatory requirements.
• Lead operational support, incident management, root-cause analysis, process improvement, automation, and technology enhancement initiatives.
• Monitor operational performance through metrics, reporting, forecasting, and trend analysis.
• Manage strategic planning, budgeting, resource allocation, vendor relationships, and operational priorities.
• Partner with leaders, business areas, technology teams, healthcare providers, clearinghouses, vendors, government agencies, regulatory bodies, and other external parties to establish priorities, resolve issues, coordinate system enhancements, and implement enterprise projects and regulatory changes.
• Perform other job-related duties as assigned within the scope of responsibilities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager