The Specialist I, EDI Claims is responsible for retrieving, processing, validating, and posting electronic claim data files into MPM’s core system, EZ-CAP®. Reporting to the Supervisor, EDI Claims, this position ensures all files are processed timely and meet compliance regulations.
Key responsibilities include developing understanding of electronic data file definitions, HIPAA ANSI 837 formats, and proprietary health plan claim data formats; navigating EZ-CAP system; using Bowman to process EPF data files into EZ-NET®; documenting and reconciling processed files; resolving rejects/post errors to ensure 100% claim record posting; attending organizational meetings; and other duties as assigned.
Minimum qualifications: High School diploma or GED equivalent, or 1 year equivalent experience in similar roles and/or with managed healthcare eligibility data. Preferred experience with EZ-CAP/EZ-NET and Smartsheet, proficiency in MS Office Suite, and understanding of managed healthcare operations.
Skills: Strong organizational, analytical, communication skills, attention to detail, team orientation, adherence to company values and policies.
- High School diploma or GED equivalent, or 1 year equivalent experience in similar role
- Experience with managed healthcare eligibility data preferred
- Experience with EZ-CAP/EZ-NET preferred
- Experience with Smartsheet preferred
- Proficiency with MS Office Suite (Word, Excel, Outlook, OneNote)
- Understanding of managed healthcare business operations preferred
- Strong organizational, analytical, and communication skills
- Attention to detail
- Team-oriented and committed to adherence to policies and values
Location
California, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
2 weeks ago