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EDI Claims Processor


The EDI Claims Processor is part of a vital team that is responsible for the input of electronically submitted claims files. The EDI Claims Processor works under strict compliance time constraints and is responsible for the timely and correct input of all claims files received. The EDI Claims Processor also provides daily technical support for EDI implementation and issue resolution that pertains to electronic claims submission.

Duties and Responsibilities

  • Adhere to the EDI transaction processes to ensure that transactions are processed accurately and on schedule, and appropriately follow up on any errors that may occur.
  • Work with internal teams and 3rd party partners to improve and scale our documentation of EDI
  • Responsible for documenting and archiving all files processed and any issues/errors that may have occurred during the upload process.
  • Retrieve daily files from numerous FTPs and send acknowledgement files outbound on the FTP.
  • Forward claims to appropriate departments for missing provider or claim information and follow up on pending claims.
  • Attend organizational meetings as required.
  • Adhere to organizational Policies and Procedures.
  • Answer client phone calls and respond to client emails.
  • Perform other tasks as assigned by Senior Management.

Minimum Job Requirements:

High School Diploma required. Previous computer experience is required.

Knowledge, Skills, and Abilities Required:

  • Strong organizational, analytical and oral/ written communication (English) skills required.
  • Must have excellent critical thinking skills and possess the ability to identify patterns and deviations from normal processes.
  • Proficiency in PC application skills, e.g., word processing, spreadsheets, preferred.
  • Must be able to follow direction and perform independently according to departmental standards when no direction is given.
  • Uses good customer service skills and respects others when communicating via the phone and email.
  • Able to work well within a team environment.
  • Familiarity with 837 file format and or EZCAP is a major plus.

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Job title: EDI Claims Processor

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