What are the responsibilities and job description for the EDI Analyst position at Heathos LLC?
Job Title: EDI Analyst
Reports to: Sr Director, Product Platform
Location: NJ (Holmdel area), FL (Ft. Lauderdale area), GA (Alpharetta area)
About Heathos
Heathos is transforming the healthcare insurance landscape through a connected, data-driven ecosystem that simplifies complexity and drives long-term success. Built on trust, innovation, and integrity, we provide technology, services, and insights that support agencies, carriers, and members at every stage. Our family of brands—FirstEnroll, AdminOne, and SonicMarketing—works together to streamline operations and deliver a seamless insurance experience.
Position Summary
The EDI Analyst is responsible for the configuration, implementation, and ongoing management of file-based operations supporting eligibility, enrollment, reporting, payment, and commission workflows across the enrollment platform. This includes both file-based integrations and API-based connections to external partners and systems.
This role serves as the subject matter expert for vendor file integrations, partnering with internal teams and external vendors to ensure accurate, secure, and timely exchange of system member, agent, product and financial data. The EDI Analyst independently interprets vendor specifications, defines internal mapping logic, and ensures file configurations align with platform standards and product requirements.
As a member of the Product Team, this role contributes broadly to platform operations, including triaging enrollment platform issues, supporting product implementation initiatives, assisting with product configuration and setup activities and ensuring operational readiness for new product launches. It also supports cross-functional initiatives and assists with additional operational or implementation-related responsibilities as needed to ensure successful product delivery and platform performance.
Key Responsibilities
File Integration Configuration
- Receive and interpret vendor file specifications related to eligibility, enrollment, payment, reporting, and other product and/or platform related processes.
- Define data mapping logic between vendor file layouts and internal platform standards.
- Configure new file integrations and API connections within the platform and associated systems (including e123) to support product implementations.
- Ensure alignment between vendor requirements and internal file structure standards.
- Establish validation rules and quality checks for new file implementations.
Vendor Coordination & Implementation
- Serve as the primary point of contact for external vendors regarding file specifications, integration requirements, transmission protocols, and testing timelines.
- Lead and coordinate integration testing cycles for both file-based and API-based connections, including validation, discrepancy identification, issue resolution, and go-live readiness.
- Clarify file specification discrepancies and propose resolution approaches.
- Maintain documentation of vendor-specific requirements and integration standards.
Monitoring, Error Management & Issue Resolution
- Monitor inbound and outbound file transmissions and API data transfer to ensure successful processing.
- Review error files, identify root causes, and implement corrective actions.
- Work directly with external vendors to investigate, troubleshoot, and resolve file transmission errors, data discrepancies, or formatting issues.
- Process vendor-requested updates to file configurations as needed.
- Triage file-related issues within enrollment platform and coordinate resolution with appropriate internal and external teams.
Payment & Commission File Oversight
- Oversee processing of payment files and commission request sheets.
- Review and audit payment-related files for accuracy prior to submission to Finance.
- Identify discrepancies, reconcile data issues, and resolve errors before final processing.
- Support financial controls through documentation and audit tracking.
Product Configuration & Operational Support
- Assist with product configuration and setup activities required to support new implementations, vendor integrations, and platform enhancements.
- Support product implementation initiatives by ensuring integration requirements align with product configuration and system rules.
- Provide operational support and triage assistance within e123 and related systems as needed to maintain platform stability.
- Assist with operational triage and issue resolution impacting file-based workflows.
- Contribute to release readiness planning for features affecting file integrations.
- Support platform configuration activities and participate in general audit, cleanup, and system optimization initiatives to ensure ongoing accuracy, consistency, and alignment with product and operational standards
Governance & Continuous Improvement
- Maintain documentation for file standards, mapping logic, and integration processes.
- Identify opportunities to improve efficiency, automation, and reliability of file workflows.
- Recommend enhancements to internal file standards to support scalability.
Qualifications
- 2 years of experience working with structured data in file-based systems, eligibility/enrollment operations, payment processing, or related systems roles.
- Strong experience interpreting file specifications and defining data mapping logic.
- Familiarity with structured file formats (e.g., CSV, flat files, XML).
- Experience working with secure file transfer methods (e.g., SFTP).
- Strong analytical and troubleshooting skills with high attention to detail.
- Ability to independently manage multiple integration workstreams.
- Experience supporting financial file review or reconciliation preferred.
- Healthcare, benefits, or enrollment systems experience strongly preferred.
Key Competencies
- Independent judgment and decision-making
- Vendor-facing communication
- Technical problem-solving
- Operational accountability
- Process governance
- Cross-functional collaboration
Heathos is proud to be an equal opportunity and affirmative action employer. We are committed to building a workforce that is representative of the agencies, carriers, and members we serve, creating a culture of belonging, and providing an equal employment opportunity regardless of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, criminal histories consistent with legal requirements, or any other basis protected by law. See also Know Your Rights: Workplace Discrimination is Illegal.
If you have a need that requires accommodation, please let us know here.
Heathos is a binational company and, in order to facilitate efficient collaboration and communication binationally, English proficiency is a requirement for all roles unless stated otherwise in the job posting.