Technical EDI Specialist

Connect for Health Colorado•Denver, CO

23h•Hybrid

About The Position

Connect for Health Colorado is a public, non-profit entity established by the Colorado General Assembly in 2011 to create a health insurance Marketplace. Since 2013, we’ve been helping individuals, families, and small employers compare plans, apply for financial help, and buy health insurance. As Colorado’s official health insurance marketplace, we are the only place to apply for financial help to lower the monthly cost of premiums. Customers can shop online; get help by phone or online chat from Customer Service Center representatives; and access expert help from a statewide network of certified Brokers and community-based Assisters. Our mission is to increase access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado. The Technical EDI Specialist works under the direction of the Production Support Manager and serves as the organization’s lead backend technical resource for EDI transaction integrity, internal enrollment data alignment, issuer file reconciliation support, and complex production data corrections within Connect for Health Colorado’s marketplace systems. This role focuses on the internal system, database, and transaction-level components of EDI processing rather than external issuer-facing coordination. This role serves as a key technical partner to Product, Engineering, and Issuer Operations to support enrollment data reconciliation efforts, validate cross-system discrepancies, and ensure alignment between internal system data, issuer-reported information, and CMS. The Technical EDI Specialist provides deep analysis of transaction-level issues, data mismatches, and bulk correction impacts, enabling Product and Engineering to accurately define problems and implement effective solutions, while supporting Issuer Operations in resolving reconciliation discrepancies and ensuring cross-system alignment. The role also identifies systemic patterns, establishes guardrails, and surfaces actionable insights that inform and influence Product prioritization and decision-making, while strengthening data handling and system logic to prevent recurrence and improve data quality and system reliability. The position requires advanced expertise in database management (SQL/Postgres), EDI transaction processing, including 834 inbound and outbound transactions, regulatory data reporting, and cross-system financial reconciliation. This role provides required technical review and validation for high-risk and bulk production data corrections impacting enrollment and financial assistance.

Requirements

Colorado resident.
Bachelor’s degree in computer science, Information Systems, Business Administration, or a directly related field and/or equivalent years of relevant technical experience.
Minimum of 5 years of demonstrated experience supporting complex production systems involving EDI transactions, enrollment platforms, or financial data reconciliation.
Proficiency in EDI standards (X12), including experience with data mapping and translation concepts.
Strong technical knowledge of file formats such as XML and JSON.
Experience with communication protocols, including APIs and SFTP.
Advanced SQL skills for data analysis, validation, and troubleshooting.
Familiarity with tools and platforms such as Java, Swagger, and Rancher.
Experience troubleshooting regulatory or external reporting extracts.
Experience designing, reviewing, and validating database correction scripts.
Experience working within ITIL-based Incident and Problem Management frameworks.
Proficiency with tools such as JIRA Service Desk, JIRA Software, Confluence, and production. logging/monitoring tools.
Exceptional analytical thinking and pattern recognition skills.
Ability to operate independently and exercise sound technical judgment in high-impact scenarios.
Effective cross-functional collaboration and communication skills.
Ability to remain calm and decisive during time-sensitive operational periods, including Open Enrollment.

Nice To Haves

Experience working within a State-Based Marketplace or healthcare enrollment system.
Knowledge of premium subsidy calculations and federal reconciliation requirements.
Experience supporting large-scale population-impacting data corrections.

Responsibilities

Serve as the senior subject matter expert for backend EDI transactions, policy services, internal dispute resolution, and regulatory reporting.
Act as a key technical partner to Product, Engineering, and Issuer Operations to support enrollment data reconciliation and ensure cross-system alignment between internal systems, issuers, and CMS.
Translate production issues, reconciliation discrepancies, and data trends into actionable insights that inform and influence Product prioritization and decision-making.
Provide deep analysis of transaction-level issues, data mismatches, and bulk correction impacts to enable accurate problem definition and effective solution design.
Support Issuer Operations in resolving reconciliation discrepancies through validation of transaction behavior and cross-system data alignment.
Perform advanced SQL analysis to validate eligibility, enrollment, premium, and financial assistance data consistency across systems.
Review and validate high-risk and bulk Data Change Requests impacting enrollment, financial assistance, premiums, issuer reconciliation, and regulatory reporting.
Validate correction logic against transaction history, eligibility results, policy grouping, and financial assistance calculations to prevent downstream risk.
Establish and maintain review standards and governance guardrails to ensure audit readiness, regulatory compliance, and data integrity.
Identify systemic patterns and recurring issues, guide root cause analysis, and strengthen data handling and system logic to reduce recurrence.
Serve as the technical lead for high-impact production incidents involving enrollment, financial data, issuer data exchange, or reporting discrepancies.
Provide mentorship and technical oversight to Production Support team members to strengthen EDI and reconciliation capabilities.
Collaborate with BI, Issuer Operations, Architecture, Engineering, and external partners to ensure data integrity and alignment with production behavior.
Ensure adherence to Incident and Problem Management processes and contribute to operational maturity within Production Support.
Perform other duties as assigned.