ZipStaff Inc.
EDI Claims Implementation Specialist
Remote•United States•Contract
$58 - $60 hourly
$58 - $60 hourly
About the Job
Job Title: EDI Claims Implementation Specialist
Location: Remote (U.S.)
Employment Type: Contract (W2 through ZipStaff — No C2C or 1099)
Location: Remote (U.S.)
Employment Type: Contract (W2 through ZipStaff — No C2C or 1099)
About the Opportunity:
ZipStaff is seeking an EDI Claims Implementation Specialist to support a system migration for a Massachusetts Medicaid client at a major managed care organization.
You will bridge inbound claims, adjudication-system impacts, and downstream encounter reporting as the client moves from one claims platform to another. This is a hands-on implementation seat focused on healthcare claims — not a general EDI developer role and not a pure outbound reporting role.
What You’ll Do:
- Support migration of a Massachusetts Medicaid client from one claims system to another.
- Own inbound / pre-adjudication work: 837 claim ingestion from providers, including EDI intake, mapping, validation, and routing into the claims platform.
- Support post-adjudication 837 encounter reporting: extraction, mapping, validation, submission, acknowledgments, and reconciliation.
- Assess and address impacts to adjudication, eligibility, and accumulator processing during the transition.
- Validate claims and encounter data across platforms and drive defect resolution through cutover.
- Partner with functional and technical teams to keep the migration on track.
Required Qualifications:
- 5+ years hands-on EDI claims and implementation experience in healthcare insurance.
- Strong inbound claims experience (preferred over outbound) covering 837 claim ingestion, intake, mapping, validation, and routing.
- Post-adjudication experience with 837 encounter reporting, including extraction, mapping, submission, acknowledgments, and reconciliation.
- Recent experience (last 4 years) in healthcare insurance claims, eligibility, and accumulators.
- Proven experience supporting system migrations or implementations where claims processing and encounter reporting moved between platforms.
- Must be legally authorized to work in the United States without sponsorship now or in the future.
Preferred Qualifications:
- MassHealth or Medicaid experience.
- Familiarity with MassHealth 837 encounter reporting requirements.
- Experience with both inbound and outbound claims (team already has some outbound expertise).
- Behavioral health or managed care background.
Benefits:
- Health Insurance.
- Dental Insurance.
- Vision Insurance.
- 401(k) + 401(k) matching.
- Paid time off.
- Referral Program.
About ZipStaff
ZipStaff partners with leading organizations to connect skilled technology professionals with high-impact contract opportunities. We focus on quality matches, clear communication, and long-term success for candidates and clients.
To apply, submit your resume highlighting 837 inbound claims work you owned, encounter reporting you supported, and any migration or implementation projects. Non-healthcare EDI or outbound-only experience will not be considered.