Lead the development, validation, and testing of EDI 834 enrollment files.
Troubleshoot enrollment file issues and identify root causes.
Interpret enrollment business rules and translate them into technical specifications.
Provide guidance on state-specific and Marketplace/Open Enrollment requirements.
Create detailed technical enrollment scenarios to support system testing and implementation.
Convert business needs into clear technical requirements and functional documentation.
Define expected system behavior and validate enrollment processing.
Support enrollment operations teams by resolving complex enrollment and eligibility issues.
Document business and technical requirements, workflows, and process documentation.
Develop process flows and workflow diagrams.
Act as a liaison between business stakeholders and IT teams to ensure successful implementation of enrollment initiatives.
Monitor regulatory and Marketplace rule changes, particularly those impacting Open Enrollment.
Interpret New York State Marketplace enrollment requirements and ensure compliance.
Assess downstream impacts of enrollment and eligibility changes across integrated systems.
Support planning, testing, and readiness activities for Open Enrollment.

Extensive experience working with EDI 834 Enrollment transactions within a health plan environment
Strong knowledge of health plan enrollment and eligibility processes
Experience supporting Marketplace/Open Enrollment initiatives
Ability to interpret complex business rules and convert them into technical requirements
Experience documenting business requirements, technical specifications, and process flows
Strong analytical and troubleshooting skills
Excellent communication skills with the ability to work effectively across business and technical teams.

EDI Analyst

Key skills