HealthEdge

The core responsibilities are not specified, but likely involve overseeing projects, managing teams, and stakeholder engagement. | The requirements are not detailed, but likely include senior project management skills, relevant certifications, and experience in managing complex projects. | This job listing in DeKalb - GA has been recently added. Tallo will add a summary here for this job shortly.

Lead global support teams managing health plan applications, ensuring high availability, performance, and security, and coordinating with vendors and stakeholders. | Minimum 12 years of experience leading technology and support teams, with exposure to Java, Web Services, XML, SQL, AWS, and ITIL, and experience managing multiple vendors and offshore teams. | Overview About HealthEdge HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com. Position Overview: We are searching for a highly motivated Director I – Delivery Management to join our team. The IT Director will lead global teams supporting business operations of production applications critical to health plan administration. This role ensures high availability, performance, and security of applications hosted in both on-premises data centers and AWS cloud environments. The IT Director will collaborate with business leaders, technology teams, and vendors to maintain compliance with healthcare regulations and deliver exceptional service to internal and external stakeholders. Support teams manage incidents, monitor applications, schedule integrations, perform data reconciliation, analyze data, coordinate software deployments, prepares and conducts disaster recovery plans, prioritize service requests with customers, measure and meet SLA / CPI / KPIs, and perform low complexity software changes. The IT Director must build high performing teams of US based associates while coordinating with global support leadership. This role requires excellent communication, leadership, and critical thinking skills and must be an analytical person who is able to grasp customer needs and brainstorm ways to fulfill them. Your Impact: Drive administrative savings through improved processes and consolidation Ensure revenue optimization and generation through high system performance and reliability Oversee health of enterprise production ecosystem through dashboards and other available tools Ensure teams timely troubleshoot and resolve software issues with production applications Create a center of excellence approach for Service Desk and Data Operations Coordinate with other teams change and issue resolution activities related to network, middleware, hardware, OS, DB, and external application groups Work with customers to strategize major operational events and large projects while ensuring the managers are appropriately prioritizing daily work with the customers Oversee system maintenance and upgrade events across multiple vendors and customers Direct teams onshore and offshore, across multiple shifts, customers and technologies Use Jira Service Desk to improve workflow of ticket processes Administer SLA management and reporting SLA metrics in a monthly operational formats and forums Supporting the patch and updates to applications Staff oversight including goal setting and performance monitoring Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Bring: Bachelor’s degree in a related field. Minimum 12 years of relevant work experience in leading technology and support teams Exposure to an environment supporting multiple customers, functions, vendors or systems Experience managing applications using: Java, Web Services, XML, SQL Exposure to AWS Cloud Environment and on-prem infrastructure Experience with Incident Management, Release Management and exposure to ITIL practices Familiar with development, debugging and testing concepts Experience with Agile tools and methodologies including JIRA, JSM, SCRUM, Kanban Experience with CI/CD Experience working for a Healthcare company is preferred Experience in a HealthEdge solutions is desired Coach teams to quickly find and document root causes, and effectively communicate possible resolutions Communicate effectively across all levels within Technology, Business and Operations Approach problems as challenges and deal with them constructively while promoting this approach to the organization Understanding the impact of system reliability on business processes and financial performance PowerPoint, excel and presentation skills Strong planning and coordination skills Experience working in an offshore model is required HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. Geographic Responsibility: This position will be located in Atlanta, GA.Type of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Hybrid **The annual US base salary range for this position is $150,000 to $170,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.

Oversee HIPAA EDI transactions, ensure compliance, manage client relationships, and coordinate cross-functional teams. | Experience in healthcare EDI transactions, HIPAA compliance, client management, and proficiency in EDI tools and standards. | Overview About HealthEdge HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com. Position Overview: We are searching for a highly skilled and experienced Healthcare EDI & Client Engagement Manager to join our growing team. In this role, you will oversee HIPAA EDI transactions, client communications, and cross-functional coordination. This role is responsible for ensuring seamless electronic data interchange (EDI) transactions, maintaining compliance with HIPAA regulations, and managing client relationships. The ideal candidate will act as a bridge between internal teams, partners, and customers, ensuring high-quality service delivery, application of standard practices across board, prompt issue resolution, and operational excellence in EDI processes. Your Impact: Key Responsibilities: Act as a liaison between account teams, partners, and customer Act as an Inhouse HIPAA EDI transactions SME Support technology and business operations on EDI and clearinghouse Support Implementation and Sales teams as needed EDI & Compliance Management: Monitor and manage HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278, 820, etc.). Ensure timely processing and resolution of EDI-related issues, including data integrity, rejections, and errors. Collaborate with IT, Compliance, and Operations teams to troubleshoot, optimize, and enhance EDI workflows. Maintain up-to-date knowledge of HIPAA, X12 standards, and payor regulations. Conduct gap analysis to ensure EDI compliance and data accuracy. Stakeholder Management (Partner and Clients): Serve as the primary point of contact for clients and EDI partner regarding EDI, clearinghouse processes, transactions, and issue resolution. Establish and maintain strong partner relationship, proactively addressing concerns and expectations. Coordinate cross-functional teams (IT, Claims, Finance, Provider Services) to resolve client-reported issues efficiently. Lead client meetings, status updates, and performance reviews to ensure alignment and satisfaction. Provide training and guidance to internal teams and clients on EDI processes and industry changes. Operational & Performance Oversight: Report EDI transaction success rates, rejections, and turnaround times. Define and manage KPIs such as first-pass claim acceptance rate, EDI rejection rate, and processing time. Work closely with internal teams to streamline workflows and implement best practices for EDI optimization. Ensure that service-level agreements (SLAs) are met for all EDI transactions and client expectations. Identify opportunities for process improvements and automation to enhance efficiency. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Bring: Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field. 5+ years of experience in healthcare EDI transactions, client management, or payer operations. Experience in healthcare claims processing, eligibility verification, and remittance advice transactions. Strong understanding of HIPAA 5010, ANSI X12, and other EDI transaction sets (837, 835, 270/271, etc.). Strong knowledge of CMS, Medicaid, Medicare, and commercial payor regulations. Proficiency in EDI tools, SQL, data mapping, and reporting. Proven ability to manage client expectations, drive issue resolution, and lead cross-functional coordination. Excellent communication, negotiation, and stakeholder management skills. HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the USType of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote **The annual US base salary range for this position is $140,000 to $160,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.

Lead business requirements gathering and analysis for healthcare payor systems, collaborating with customers, vendors, and internal teams to implement solutions using HealthProof's core-admin ecosystem. | Bachelor's degree plus 12+ years of healthcare business analysis experience with deep knowledge of healthcare payor domains and EDI transactions, strong communication skills, and experience in onshore/offshore Agile environments. | Overview About HealthEdge HealthEdge is trusted to provide the technology and services that power health plans' most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com. Position Overview: We are searching for a highly skilled and experienced Senior Business System Analyst to join our growing team. The Senior Business System Analyst (BSA) will help in capturing the business requirements to run the Health plan customer's Core admin business functions while implementing UST HealthProof's core-admin ecosystem. The BSA will work with the Health Plan Customers, third party vendors/partners, Internal product teams, solution architects and product owners to define the business rules and processes required for implementation You should possess deep knowledge & experience in HealthCare Payor domains (Claims adjudication, Enrollment, Provider, Payment). You should have excellent requirement elicitation and communication skills and ability to engage as part of a team working both physically and virtually. Also, you should be able to identify the customer problems and work with Solution Architect(s) to provide the solution to customer. Your Impact: • Leading business requirement conversations with customer and internal teams. • Managing the end-to-end requirements involving all the stakeholders. • Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems. • Create solutions for current business processes using UST HealthProof's core-admin ecosystem. • Negotiate with client to develop processes that are current and applicable to the situation. • Collaborate with business users, management, IT, and offshore staff to ensure the finish product meets project objectives and client expectations by applying 'Agile like' project methodology. • Instrumental in analyzing the healthcare business requirements and translating them to functional and technical requirements. • Identify opportunities for automation, performance improvements, reusability. • Develop high level workflow diagrams and system context diagrams. • Document the understanding of the process flow using swim lanes diagrams. • Produce the Requirements plan that aligns with the overall Project Implementation plan. • Dictate the risks and dependencies in the timely manner with the Customer to complete the requirement gathering to meet up with the project plan dates. • Must work with Offshore Business Analysts to elaborate user stories. • Conduct Requirement walk through with the customer and internal/external stakeholders. • Collaborate with the development team & QA team to ensure the finish product meets project objectives and client expectations. • Contribute towards sprint planning, retrospective, go-live/no go-live evaluation meetings. • Conduct Demo of MVPs for the customer. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Bring: • Bachelor's degree or higher in business or technical field • 12+ years of relevant work experience in business analysis • Knowledgeable in Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial) • Exposure to healthcare eco-systems from partners like HealthEdge, TriZetto , NASCO, Advantasure or Change Healthcare • Experience with mapping of EDI healthcare transactions (837, 834, 835,270/271, 276/277, 278) • Experience in analysing the business requirements and translating/mapping them to technical requirements in EDI technology by analysing implementation/companion/TR3 guides • Experience documenting requirements or user stories and communicating the requirements to technical teams, partners/vendors or product teams Experience working in an onshore/offshore model is a must • Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus • Understanding of SQL, XSDs is a plus • Awareness to Agile tools and scrum methodologies • Communication skills with peers, customers, and partners including the ability to convey information effectively HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the USType of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: • The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. • Work across multiple time zones in a hybrid or remote work environment. • Long periods of time sitting and/or standing in front of a computer using video technology. • May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote • *The annual US base salary range for this position is $100,000 to $125,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education. Employment Type: FULL_TIME