Operations Specialist (EDI Implementation Support)

Imagine360 is seeking an Operations Specialist to join the team! We are seeking a highly motivated Operations Specialist to support EDI (Electronic Data Interchange) implementations and post-implementation production support, focusing on 834 Enrollment and 837 Claims transactions with third-party administrators (TPAs). This role is critical in ensuring smooth onboarding, testing, and operational stability of EDI integrations, while actively collaborating across departments to resolve issues and improve processes. The Operations Specialist will act as the main point of contact for TPAs during and after implementation and will also be responsible for documenting operational procedures and ensuring repeatable, scalable workflows. Position Location: 100% remote Responsibilities include but are not limited to: EDI Implementation Support: Participate in and support technical calls related to EDI implementation efforts. Assist in testing of 837 outbound files with TPAs to ensure compliance with specifications and claims processing requirements. Track, manage, and report on implementation milestones and deliverables. Collaborate closely with internal stakeholders to ensure timely and accurate file exchange setup and validation. Production Support & Operational Oversight: Serve as the primary operational contact for TPAs post-implementation. Monitor and resolve production issues, including claims routing, file errors, and processing discrepancies. Triage and resolve inquiries related to aging claims, inventory backlogs, and escalated partner concerns. Escalate and track systemic issues for resolution with the appropriate technical or business teams. Cross-Functional Collaboration: Work collaboratively with Finance, Claims Audit, IT, Client Implementations, Client Experience, and Member Services teams to: Support issue resolution across claim, enrollment, and eligibility processes. Provide updates and operational insights into partner performance and transaction health. Coordinate root cause analysis and implement corrective actions as needed. Ensure partner needs are reflected in service delivery and internal processes Process Documentation & SOP Development: Develop and maintain detailed SOPs for new EDI implementations and ongoing operational tasks. Identify opportunities for operational process improvements and automation. Ensure all documentation is updated and accessible for relevant teams. Partner Relationship Management: Act as the main operational liaison to third-party administrators. Conduct and lead monthly operational check-ins with partners to review claims aging, performance metrics, and open items. Maintain detailed documentation of partner communications, tracking issues to resolution. Required Experience/Education: Bachelor's Degree or 1+ years of experience in EDI operations or healthcare data exchange, with hands-on exposure to 834/837 HIPAA transaction sets. Strong understanding of healthcare claims processing, eligibility/enrollment workflows, and TPA coordination. Preferred experience: Experience with clearinghouses, EDI mapping tools, or healthcare integration platforms. Familiarity with payer systems, claims adjudication processes, or TPA operations. Background in writing SOPs or internal process documentation. Previous analytics and reporting skills a plus. Skills and Abilities: Demonstrated ability to work cross-functionally in a fast-paced environment. Excellent communication, analytical, and problem-solving skills. Proven ability to handle multiple competing priorities with attention to detail. What can Imagine360 offer you? Multiple Health plan options Company paid employee premiums for disability and life insurance Parental Leave Policy 20 days PTO to start / 10 Paid Holidays Tuition reimbursement 401k Company contribution Company paid Short & Long term Disability plus Life Insurance Professional development initiatives / continuous learning opportunities Opportunities to participate in and support the company's diversity and inclusion initiatives Want to see our latest job opportunities? Follow us on LinkedIn Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation Apply To This Job