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:
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
