Manager - Payer Operations

Summary

Join Experian Health as a Manager – Payer Operations, leading a team of EDI Analysts. You will optimize connectivity, ensure operational excellence in electronic transaction workflows, and serve as an escalation point for issue resolution. Responsibilities include overseeing daily operations, resolving EDI errors, collaborating with partners, developing documentation, implementing automation, and monitoring team performance. You will also represent the team in meetings and maintain knowledge of healthcare EDI standards. This role requires a Bachelor's degree, 5+ years of healthcare EDI experience, and 2+ years of people management experience. Proficiency in various technologies and Agile methodologies is also needed.

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, including 27x, 83x, and 278
• 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)

Responsibilities

• Lead a team of EDI Analysts (Levels 1–3) 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 (270/271, 835/837, 278, 275) and evolving industry requirements

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