Elite Technical is seeking an EDI Application Programmer to assist in daily EDI activities including but not limited to correcting files for claims inbound, commercial eligibility outbound files and support daily Medicare eligibility processing and reconciliation activities for our clients healthcare populations. This includes monitoring, processing, and troubleshooting eligibility file data errors, coordinating corrective actions with internal stakeholders and external vendors, validating enrollment/disenrollment outcomes, resolving exceptions, and coordinating cross-functional follow-up to ensure accurate, compliant, and auditable production operations.

This position supports and enhances production operations by coordinating and/or performing ongoing eligibility processing, file monitoring, validation activities, and exception management for Medicare-related populations supported by the EDI team.

The role interfaces with internal departments (e.g., Enrollment, Operations, Finance) and external partners to ensure eligibility transactions, attributes/coverage indicators, and reconciliation outputs remain accurate and consistent across systems and reporting.

The selected candidate will work with others as needed to obtain or create test data as required to validate system changes/enhancements.

Required Skills

- AS of BS degree in related field is preferred
- 5+ years of direct experience
- Knowledge of CMS Employee Group Health Plan (EGHP) requirements and/or Medicare Advantage Plans.
- Experience with health insurance systems, claims processing systems, is required.
- Experience supporting eligibility/enrollment operations, data reconciliation, and file-based integrations in a healthcare, insurance, or benefits administration environment.
- Knowledge of HIPAA X12 EDI transaction sets, specifically: 834 (Enrollment), 835 (Remittance Advice), 837 (Claims), and 277 (Claim Status Response) is reuquired.
- QNXT experience a plus.
- Experience with SQL or other software development tools preferred.