Manager - Payer Operations - Remote

Overview

The Manager – Payer Operations will lead a team of EDI Analysts responsible for optimizing connectivity monitoring and ensuring operational excellence across electronic transaction workflows.

In Short

• Lead a team of EDI Analysts assuring optimal performance and providing coaching for professional development.
• Oversee daily operations related to payer transaction monitoring, and issue resolution.
• Ensure identification, escalation, and resolution of EDI transaction errors and connectivity issues.
• Coordinate with external trading partners and company partners to resolve issues.
• Guide the development of EDI documentation and process documentation.
• Help implement automation and AI technologies to improve operational efficiency.
• Monitor team workload and performance metrics, ensuring adherence to performance and service level expectations.
• Implement process improvements, including documentation standards, tooling enhancements, and cross-training plans.
• Represent the team in meetings and industry forums.
• Maintain an understanding of healthcare EDI standards and evolving industry requirements.

Requirements

• Bachelor's degree in business, Computer Science, Healthcare Administration, or related field.
• 5+ years of experience in healthcare EDI, payer operations, or revenue cycle management required.
• 2+ years of direct people management experience overseeing technical or operational teams required.
• Knowledge of X12 and HL7 transactions.
• Familiarity with payer/provider enrollment processes, EDI protocols, and API/web capture methods.
• Proficiency in Salesforce, JIRA, Microsoft 365, and data analytics tools (especially Excel).
• Experience with Agile methodologies (Scrum, Kanban).

Benefits

• Great compensation package and bonus plan.
• Core benefits including medical, dental, vision, and matching 401K.
• Flexible work environment, ability to work remote, hybrid or in-office.
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays.
• Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html.