EDI Specialist

We are seeking a highly skilled Billing & Enrollment Exchange Specialist to join our team at Delta Diversified Enterprises. This role is responsible for the accurate and timely processing of electronic enrollment files, submission of the inbound enrollment reconciliation file, and answering escalated inquiries from Federal and State Based Exchanges.

• Process daily enrollment files received via electronic data feed and perform updates on accounts that cannot automatically be updated.
• Establish, document, and maintain EDI procedures in a shared directory.
• Keep the department up to date on EDI best practices.
• Document processes and changes as it relates to the Federal and State Exchanges.
• Participate in Federal and State Exchange meetings and bring forth any required changes as a result of those meetings.
• Act as a Subject Matter Expert (SME) and escalation specialist related to problems or situations within EDI.
• Responsible for accurate application of advanced premium tax credits and/or individual consumer premium payments.
• Reconcile advanced premium tax credit and ensure policies are billed appropriate premium rates.
• Perform enrollment reconciliation based on state and federal reconciliation processes.
• Participate in user acceptance testing for system and/or internal/external website changes as it relates to Exchange business as a SME.
• Work collectively with technical partners to ensure proper file submission, error resolution, and improve data collection and management.
• Collaborate with Client Experience and Product Services team to relay any changes that are required of the Client as a result of a Federal or State Exchange change.
• Monitor and respond to inquiries from the Federal or State Exchange through the appropriate escalation paths.
• Identify, communicate, and escalate critical issues to appropriate internal and external parties.
• Serve as a technical advisor to non-technical members of the team.
• Participate in team meetings and training sessions.
• Attend and participate in meetings and/or projects as assigned by Leadership.
• Process enrollment applications and change forms from paper, EDI834, image, or phone contact in accordance with established procedures using multiple systems.
• Learn and maintain knowledge of Wyssta policy processing agreements for all clients.
• Respond promptly and professionally to inquiries from internal and external consumers relating to enrollment and billing issues; customer service may be provided by telephone, web, email, or other type of communication.

• Associate degree in business or related field preferred.
• 1-2 years related EDI experience preferred.
• Computer skills, with demonstrated proficiency in MS Office Suite applications with intermediate Excel skills required.
• Strong interpersonal, written, and oral communication skills with the ability to communicate effectively with non-technical staff.
• Self-motivated and directed.
• Ability to effectively prioritize and execute tasks.
• Analytical and problem-solving abilities.
• Must be well-organized and attentive to detail.
• Strong customer service orientation.
• Experience working both in a team-oriented, collaborative environment and independently.

We are an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.