[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.ResponsibilitiesParticipate in and support technical calls related to EDI implementation effortsAssist in testing of 837 outbound files with TPAs to ensure compliance with specifications and claims processing requirementsTrack, manage, and report on implementation milestones and deliverablesCollaborate closely with internal stakeholders to ensure timely and accurate file exchange setup and validationServe as the primary operational contact for TPAs post-implementationMonitor and resolve production issues, including claims routing, file errors, and processing discrepanciesTriage and resolve inquiries related to aging claims, inventory backlogs, and escalated partner concernsEscalate and track systemic issues for resolution with the appropriate technical or business teamsWork collaboratively with Finance, Claims Audit, IT, Client Implementations, Client Experience, and Member Services teams to support issue resolution across claim, enrollment, and eligibility processesProvide updates and operational insights into partner performance and transaction healthCoordinate root cause analysis and implement corrective actions as neededEnsure partner needs are reflected in service delivery and internal processesDevelop and maintain detailed SOPs for new EDI implementations and ongoing operational tasksIdentify opportunities for operational process improvements and automationEnsure all documentation is updated and accessible for relevant teamsAct as the main operational liaison to third-party administratorsConduct and lead monthly operational check-ins with partners to review claims aging, performance metrics, and open itemsMaintain detailed documentation of partner communications, tracking issues to resolutionSkillsBachelor's Degree or 1+ years of experience in EDI operations or healthcare data exchange, with hands-on exposure to 834/837 HIPAA transaction setsStrong understanding of healthcare claims processing, eligibility/enrollment workflows, and TPA coordinationDemonstrated ability to work cross-functionally in a fast-paced environmentExcellent communication, analytical, and problem-solving skillsProven ability to handle multiple competing priorities with attention to detailExperience with clearinghouses, EDI mapping tools, or healthcare integration platformsFamiliarity with payer systems, claims adjudication processes, or TPA operationsBackground in writing SOPs or internal process documentationPrevious analytics and reporting skills a plusBenefitsMultiple Health plan optionsCompany paid employee premiums for disability and life insuranceParental Leave Policy20 days PTO to start / 10 Paid HolidaysTuition reimbursement401k Company contributionCompany paid Short & Long term Disability plus Life InsuranceProfessional development initiatives / continuous learning opportunitiesOpportunities to participate in and support the company's diversity and inclusion initiativesCompany OverviewImagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. It was founded in 2003, and is headquartered in Philadelphia, Pennsylvania, USA, with a workforce of 1001-5000 employees. Its website is https://mibenefits.imagine360.com.