EDI QA ANALYST

The EDI QA Analyst works closely with external vendors during implementations to communicate testing expectations, coordinate validation activities, and address vendor feedback. Operating in a production-adjacent environment, the role ensures data accuracy, file integrity, and carrier readiness through structured test planning, test data preparation, scenario validation, defect identification and classification, and thorough documentation within the carrier file/EDI delivery lifecycle.

In addition, the analyst collaborates cross-functionally with requirements, development, and implementation teams to develop comprehensive test plans, manage testing activities, and work through ticketing queues to ensure timely and high-quality file delivery.

Post-production, the EDI QA Analyst is responsible for ongoing monitoring, review, and resolution of carrier error reports, while identifying trends and opportunities for continuous process improvement.

Key Responsibilities and Duties

Carrier/Vendor File Validation

•     Validate outbound carrier/vendor files (ANSI/HIPAA 834 and related formats) for structural integrity, format compliance, eligibility accuracy, and carrier-specific requirements before transmission.

•     Collaborate with external carriers/vendors and internal teams, including development and operations, to validate file behavior and resolve discrepancies.

Scenario-Based Testing

•     Develop and execute structured test scenarios covering eligibility rules, enrollment transactions, life events, and carrier-specific behaviors across internal and external testing phases.

End-to-End Data Reconciliation

•     Trace and reconcile data from upstream systems through platform outputs to final vendor files using SQL, reports, and control totals to ensure data integrity.

•     Test Planning & Requirements Traceability

o  Translate carrier/vendor and business requirements into structured test plans, reusable test cases, and traceable validation scenarios aligned to standardized templates.

•     Test Data Preparation

o  Identify, prepare, and manage representative test populations across systems and reporting environments to support validation cycles.

•     Defect Identification & Routing

o  Analyze validation results, classify defects (requirements, configuration, data, system issues), and manage QA tickets through defined workflows, ensuring proper routing, status tracking, ownership, and timely closure.

•     Documentation & Continuous Improvement

o  Provide regular status updates on QA progress, risks, and dependencies aligned to timelines and release schedules.

o  Maintain QA documentation (test plans, validation evidence, file layouts, queries, defect patterns) while building reusable test assets, vendor test plan libraries, and supporting future automation initiatives.

o  Help establish and maintain a vendor test plan library in support of all vendor relationships.

o  Drive automation and validation improvements.

•     Production Monitoring & Carrier Error Resolution

o  Review carrier acknowledgement and error reports (e.g., 999, rejection reports)

o  Investigate and resolve rejected records.

o  Coordinate corrections and reprocessing.

o  Ensure timely resolution within SLA.

•     Trend Analysis & Continuous Improvement – Post-production

o  Analyze recurring carrier errors and identify patterns.

o  Provide insights into upstream data or configuration issues.

o  Recommend improvements to reduce rework and increase first-pass success.

Required Qualifications

•     Bachelor’s degree in Computer Science or a related technical field (or equivalent experience).

•     Minimum of 2 years of experience in health insurance or Health & Welfare (H&W) benefits administration.

•     Experience working with carrier files, EDI transactions, or HIPAA 834 files in a production or operational environment.

•     Strong understanding of eligibility and enrollment processes, including effective date logic and life event transactions.

•     Hands-on experience with SQL for data validation, reconciliation, and defect analysis.

•     Strong analytical skills with a high level of attention to detail, especially in regulated environments with low tolerance for error.

Preferred Qualifications

•     Familiarity with QA best practices and Quality Management Systems (QMS), including frameworks that ensure consistent compliance with customer and regulatory requirements while driving continuous improvement and efficiency.

•     Experience with EDI testing and carrier integration environments.

•     Exposure to COBRA processes within benefits administration.

•     Experience with test automation and test case management tools.

•     Familiarity with AI-assisted testing or quality engineering practices.

•     Experience in preparing, validating, and analyzing test data across multiple systems.

•     Solid understanding of data models and relational database concepts.

•     Experience using defect tracking and ticketing systems such as JIRA (or similar tools).

Skills

EDI, EDI management, Health care administration