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 health