Senior EDI with Healthcare Payer (Facets Ecosystem) Support Specialist

Job Summary

We are seeking an experienced Senior EDI Support Specialist with strong expertise in Healthcare Payer EDI operations, HIPAA X12 transactions, Edifecs, TriZetto HIPAA Gateway, and Facets-integrated environments.

The ideal candidate will provide L2/L3 production support, troubleshoot complex EDI transaction failures, manage trading partner integrations, perform root cause analysis (RCA), and ensure seamless EDI processing across Claims, Membership, Enrollment, Billing, Provider, and Payment functions.

Candidates must have hands-on experience supporting large-scale healthcare payer environments, managing production incidents, and maintaining HIPAA-compliant EDI transaction workflows.

Key Responsibilities

• Provide L2/L3 production support for enterprise EDI platforms integrated with TriZetto Facets.

• Monitor, troubleshoot, and resolve EDI transaction failures, claim rejections, reconciliation issues, and file transmission errors.

• Support and maintain Edifecs Suite, TriZetto HIPAA Gateway, BizTalk Server, and Facets-integrated applications.

• Troubleshoot HIPAA X12 transactions, including 834, 837, 835, 270/271, 276/277, 278, and 820.

• Analyze and resolve EDI acknowledgment issues involving TA1, 999, and 277CA.

• Perform Root Cause Analysis (RCA), incident management, problem resolution, and production performance optimization.

• Manage trading partner onboarding, EDI mapping validation, certification, testing, and production deployments.

• Support batch processing, file transfers, SFTP connectivity, and integration workflows.

• Collaborate with business teams, application support, infrastructure teams, vendors, and external trading partners.

• Maintain operational documentation, incident reports, support procedures, and compliance with HIPAA requirements.

Required Technical Skills

• EDI Platforms: Edifecs Suite, TriZetto HIPAA Gateway, BizTalk Server.

• Healthcare Payer: TriZetto Facets, Claims, Membership, Enrollment, Provider, Billing, and Payment processing.

• HIPAA X12 Transactions: 834, 837P, 837I, 837D, 835, 270/271, 276/277, 278, 820, TA1, 999, and 277CA.

• Databases: SQL Server, Oracle, SQL querying, and data validation.

• Operating Systems: Unix/Linux.

• Integration & File Transfer: SFTP, batch processing, file transmission, and API integrations.

• Data Formats: XML, XSD, and JSON.

• Production Support: L2/L3 support, incident management, troubleshooting, RCA, monitoring, and release support.

Required Experience

• 8+ years of overall IT experience.

• 5+ years of Healthcare Payer and EDI experience.

• 3+ years of hands-on experience with Edifecs and/or TriZetto HIPAA Gateway environments.

• Strong experience supporting HIPAA X12 EDI transactions in production.

• Proven experience with Facets-integrated healthcare payer ecosystems.

• Experience in trading partner management, EDI testing, production monitoring, and incident resolution.

• Ability to troubleshoot complex issues across EDI gateways, databases, file transfers, and downstream applications.

Preferred / Nice-to-Have Skills

• Knowledge of HL7 and FHIR standards.

• Experience with MuleSoft or Boomi integration platforms.

• Scripting knowledge in Groovy, JavaScript, PowerShell, or Shell scripting.

• Experience with ServiceNow for incident, problem, and change management.

• Experience supporting large-scale healthcare payer platforms and high-volume EDI operations.