Technical Support Representative - Claims EDI
Job Description
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.
Be part of a team that makes a real difference.
Job Description
Core Responsibilities
- Provides technical and customer support for Regulatory Reporting Solutions EDI Claims system to:
- CMS (Centers for Medicare and Medicaid Services) clients
- Workers' Compensation FROI/SROI clients
- Auto Trigger clients
Technical Knowledge & Analysis
- Demonstrates extensive knowledge of the IAIABC standard across all Releases
- Conducts comprehensive business analysis of:
- Jurisdictional Requirements
- Client import files
- Baseline data
- Trigger rules
- Sequencing/stacking rules
- Jurisdictional acknowledgement files
- Performs import/export testing of IAIABC flat files and XML formats
- Conducts extensive testing to troubleshoot product bugs and defects
- Monitors and resolves system alerts
- SQL proficiency
- Utilizes SQL to query databases, extract relevant data, and generate custom reports for analysis and troubleshooting.
- Applies database querying expertise to identify patterns, resolve client issues, and support data-driven decision making
Client Support & Regulatory Expertise
- Serves as liaison between clients and jurisdictions
- Analyzes and provides feedback to clients on:
- Jurisdictional requirements
- IAIABC requirements for all Releases
- New and updated state implementations
- Assists clients with claim rejections
Process Improvement & Documentation
- Proposes solutions for product enhancements and defects
- Assists with maintaining system and process documentation
Qualifications
- 2+ years related experience or 1 year related experience and a college degree or medical/technical certification required
- Understanding of IAIABC
- Understanding of Workers' Compensation Claims Reporting
- Familiar with workcomp.net or previous industry experience
- Workers' compensation knowledge/background required
Benefits
We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $18.65 - $27.40 hourly, and will be based on a number of additional factors including skills, experience, and education.
The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.
#LI-MC1
- 2+ years related experience or 1 year related experience and a college degree or medical/technical certification required
- Understanding of IAIABC
- Understanding of Workers' Compensation Claims Reporting
- Familiar with workcomp.net or previous industry experience
- Workers' compensation knowledge/background required
Core Responsibilities
- Provides technical and customer support for Regulatory Reporting Solutions EDI Claims system to:
- CMS (Centers for Medicare and Medicaid Services) clients
- Workers' Compensation FROI/SROI clients
- Auto Trigger clients
Technical Knowledge & Analysis
- Demonstrates extensive knowledge of the IAIABC standard across all Releases
- Conducts comprehensive business analysis of:
- Jurisdictional Requirements
- Client import files
- Baseline data
- Trigger rules
- Sequencing/stacking rules
- Jurisdictional acknowledgement files
- Performs import/export testing of IAIABC flat files and XML formats
- Conducts extensive testing to troubleshoot product bugs and defects
- Monitors and resolves system alerts
- SQL proficiency
- Utilizes SQL to query databases, extract relevant data, and generate custom reports for analysis and troubleshooting.
- Applies database querying expertise to identify patterns, resolve client issues, and support data-driven decision making
Client Support & Regulatory Expertise
- Serves as liaison between clients and jurisdictions
- Analyzes and provides feedback to clients on:
- Jurisdictional requirements
- IAIABC requirements for all Releases
- New and updated state implementations
- Assists clients with claim rejections
Process Improvement & Documentation
- Proposes solutions for product enhancements and defects
- Assists with maintaining system and process documentation