[Remote] Operations Specialist (EDI Implementation Support)

Note: The job is a remote job and is open to candidates in USA. Imagine360 is a health plan solution company that combines over 50 years of self-funding healthcare expertise. They are seeking an Operations Specialist to support EDI implementations and post-implementation production support, focusing on 834 Enrollment and 837 Claims transactions with third-party administrators. The role involves collaborating across departments to resolve issues and improve processes while acting as the main point of contact for TPAs.

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
• Work collaboratively with Finance, Claims Audit, IT, Client Implementations, Client Experience, and Member Services teams to 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

Skills

• 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
• 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

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

Company Overview