Operations Specialist (EDI Implementation Support)

Imagine360 • ,

1d • Remote

About The Position

Imagine360 is seeking a highly motivated Operations Specialist to support EDI (Electronic Data Interchange) implementations and post-implementation production support, focusing on 834 Enrollment and 837 Claims transactions with third-party administrators (TPAs). This role is critical in ensuring smooth onboarding, testing, and operational stability of EDI integrations, while actively collaborating across departments to resolve issues and improve processes. The Operations Specialist will act as the main point of contact for TPAs during and after implementation and will also be responsible for documenting operational procedures and ensuring repeatable, scalable workflows.

Requirements

• Bachelor's Degree or 1+ years of experience in EDI operations or healthcare data exchange, with hands-on exposure to 834/837 HIPAA transaction sets.
• Strong understanding of healthcare claims processing, eligibility/enrollment workflows, and TPA coordination.
• Demonstrated ability to work cross-functionally in a fast-paced environment.
• Excellent communication, analytical, and problem-solving skills.
• Proven ability to handle multiple competing priorities with attention to detail.

Nice To Haves

• Experience with clearinghouses, EDI mapping tools, or healthcare integration platforms.
• Familiarity with payer systems, claims adjudication processes, or TPA operations.
• Background in writing SOPs or internal process documentation.
• Previous analytics and reporting skills a plus.

Responsibilities

• Participate in and support technical calls related to EDI implementation efforts.
• Assist in testing of 837 outbound files with TPAs to ensure compliance with specifications and claims processing requirements.
• Track, manage, and report on implementation milestones and deliverables.
• Collaborate closely with internal stakeholders to ensure timely and accurate file exchange setup and validation.
• Serve as the primary operational contact for TPAs post-implementation.
• Monitor and resolve production issues, including claims routing, file errors, and processing discrepancies.
• Triage and resolve inquiries related to aging claims, inventory backlogs, and escalated partner concerns.
• Escalate and track systemic issues for resolution with the appropriate technical or business teams.
• Support issue resolution across claim, enrollment, and eligibility processes.
• Provide updates and operational insights into partner performance and transaction health.
• Coordinate root cause analysis and implement corrective actions as needed.
• Ensure partner needs are reflected in service delivery and internal processes.
• Develop and maintain detailed SOPs for new EDI implementations and ongoing operational tasks.
• Identify opportunities for operational process improvements and automation.
• Ensure all documentation is updated and accessible for relevant teams.
• Act as the main operational liaison to third-party administrators.
• Conduct and lead monthly operational check-ins with partners to review claims aging, performance metrics, and open items.
• Maintain detailed documentation of partner communications, tracking issues to resolution.

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start
• 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

What This Job Offers

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