Job Description

Job Description

We are looking for an experienced Senior EDI Developer with strong hands-on expertise in the Healthcare Payer domain, Facets Claims, HIPAA X12 transactions, Edifecs, and TriZetto HIPAA Gateway . The ideal candidate will have extensive experience designing, developing, testing, and supporting EDI integrations within a Facets-based healthcare payer environment , with a primary focus on Claims processing and related workflows across Membership, Enrollment, Provider, and Payment. Candidates must demonstrate practical experience in EDI mapping, transaction validation, trading partner integrations, production support, and high-volume transaction processing. Strong knowledge of HIPAA compliance, SQL, Unix/Linux, SFTP, and batch processing is essential. Important: Hands-on experience with Facets Claims is mandatory. Candidates with only general healthcare, provider-side, or EDI experience without relevant Facets Claims exposure will not be considered suitable.

Key Responsibilities

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• Design, develop, enhance, and maintain healthcare EDI solutions using Edifecs, TriZetto HIPAA Gateway, BizTalk Server, or equivalent platforms .
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• Develop, configure, and optimize EDI maps, validation rules, routing logic, and transaction processing workflows.
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• Implement and support HIPAA X12 transactions across Claims, Membership, Enrollment, Provider, and Payment domains.
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• Work directly with Facets Claims integrations, supporting claims-related EDI processing and downstream system interfaces.
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• Develop and maintain trading partner integrations, including onboarding, connectivity, testing, certification, and production deployment.
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• Implement EDI validation, error handling, acknowledgements, reconciliation, and exception management.
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• Support high-volume EDI transaction processing and optimize performance, reliability, and processing efficiency.
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• Troubleshoot production issues, perform root cause analysis, and implement corrective and preventive measures.
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• Work with SQL Server or Oracle databases to validate data, investigate issues, and support reconciliation.
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• Develop and maintain batch processes, SFTP integrations, and Unix/Linux shell scripts.
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• Support API-based integrations and data exchange using XML, XSD, JSON, and related technologies.
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• Collaborate with Facets teams, business analysts, QA, trading partners, and technical leads to deliver reliable integrations.
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• Create technical documentation, low-level designs, test cases, deployment plans, and support documentation.
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• Participate in code reviews, testing, release management, and continuous improvement initiatives.
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• Ensure adherence to HIPAA requirements, development standards, quality controls, and project SLAs.
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Required Qualifications – Mandatory Skills

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• Healthcare Payer Domain: 5+ years of experience.
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• EDI Development: 5+ years of hands-on development experience.
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• Edifecs Suite: 3+ years of experience with XEngine, SpecBuilder, Trading Partner Management (TPM), and Validation & Compliance.
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• TriZetto HIPAA Gateway: 3+ years of hands-on experience.
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• Facets: Mandatory hands-on experience, specifically with Facets Claims .
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• HIPAA X12 Transactions: Strong hands-on experience in development, mapping, validation, and troubleshooting.
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• Trading Partner Integrations: Experience implementing and supporting external trading partner interfaces.
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• EDI Mapping and Validation: Experience developing maps, validation rules, acknowledgements, and exception-handling workflows.
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• Database Technologies: Working experience with SQL Server or Oracle.
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• Unix/Linux: Experience with command-line operations and troubleshooting.
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• SFTP and Batch Processing: Experience supporting secure file transfers and scheduled EDI processing.
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• API Integrations: Experience integrating EDI solutions with APIs and downstream systems.
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• Technical Documentation: Ability to create design documents, test cases, implementation guides, and support documentation.
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• Strong analytical, troubleshooting, communication, and problem-solving skills.
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HIPAA X12 Transactions

Candidates should demonstrate practical experience developing, mapping, validating, or supporting the following transactions:

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• 834: Benefit Enrollment and Maintenance.
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• 837P / 837I / 837D: Healthcare Claims – Professional, Institutional, and Dental.
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• 835: Healthcare Claim Payment and Remittance Advice.
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• 270 / 271: Eligibility Inquiry and Response.
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• 276 / 277: Claim Status Inquiry and Response.
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• 278: Healthcare Services Review and Authorization.
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• 820: Premium Payment.
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• TA1, 999, and 277CA: Interchange and transaction acknowledgements.
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Candidates must be able to explain which transactions they personally developed or supported and how those transactions interacted with Facets Claims or other payer systems.

Preferred Qualifications

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• Experience with BizTalk Server for EDI processing and integration.
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• Experience with HL7/FHIR healthcare interoperability standards.
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• Familiarity with MuleSoft or Boomi integration platforms.
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• Scripting or programming experience using Groovy, JavaScript, PowerShell, or Shell scripting.
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• Experience supporting Blue Cross Blue Shield (BCBS) or other healthcare payer environments.
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• Experience with claims reconciliation, payment processing, enrollment interfaces, and production EDI operations.
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• Experience with automated validation, monitoring, and error-handling frameworks.
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ABOUT BRICKRED SYSTEMS

BrickRed Systems is a global leader in next-generation technology consulting and workforce solutions, specializing in delivering high-quality talent across digital, engineering, marketing, analytics, finance, operations, and business transformation domains. With a strong emphasis on innovation, scalability, and client success, BrickRed Systems helps organizations solve complex business challenges by providing skilled professionals across strategy, technology, creative, and operational functions. BrickRed fosters a culture of continuous learning, collaboration, and excellence, enabling professionals to contribute to high-impact global initiatives while advancing their careers.

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