EDI Enrollment Specialist

Job Description: Sr. EDI Enrollment Specialist (US Healthcare – TPA)

Location: Malad West, Mumbai

Shift: 6:30 PM – 3:30 AM

About the Role

We are hiring an experienced EDI Enrollment Specialist to manage member eligibility, enrollment files (EDI 834), and health plan configuration for a US-based Third-Party Administrator (TPA).

This role is ideal for someone who has worked in US health insurance operations and understands how enrollment data flows between systems, vendors, and clearinghouses. Accuracy and attention to detail are critical, as even small data errors can impact claims and ID card generation.

Key Responsibilities

Member Enrollment & Eligibility

Process and audit member enrollments (new groups, renewals, and life events)
Handle EDI 834 enrollment files
Ensure accurate member data across internal systems
EDI & Data Mapping

Review, validate, and map 834 files
Ensure data is correctly transmitted to vendors and partners
Troubleshoot file errors and resolve discrepancies
Plan & ID Card Configuration

Configure plan details including copays, deductibles, and networks
Ensure accurate ID card setup (group number, alpha prefix, contact details)
Maintain compliance with US health plan requirements
Vendor Coordination

Work with clearinghouses and vendors (e.g., Zelis, Change Healthcare, MPX, Echo)
Support new group implementations and go-live activities
Perform root cause analysis for enrollment or ID card issues
Required Experience

3+ years in US Healthcare eligibility & enrollment
Hands-on experience with EDI 834 files
Experience working in TPA or health insurance operations
Knowledge of plan configuration and benefit setup
Exposure to vendor integrations or clearinghouses preferred
Skills We’re Looking For

Strong attention to detail
Good understanding of US health insurance processes
Ability to troubleshoot and resolve data issues
Comfortable handling structured data and system workflows
Ability to manage multiple implementations and deadlines
Job Type: Full-time

Pay: ₹600,000.00 - ₹1,200,000.00 per year

Benefits:

Health insurance
Leave encashment
Paid sick time
Paid time off
Provident Fund
Ability to commute/relocate:

Malad, Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (Preferred)
Application Question(s):

Have you worked directly with enrollment files such as 834s or eligibility data mapping?
Where do you reside?
Education:

Bachelor's (Preferred)
Experience:

US Healthcare eligibility & enrollment: 3 years (Preferred)
Location:

Malad, Mumbai, Maharashtra (Preferred)
Shift availability:

Night Shift (Required)
Overnight Shift (Required)
Work Location: In person