Healthcare EDI and Insurance Discovery Team Lead (Remote)

Team Leadership & Strategy:

• Lead, mentor, and develop a team of EDI and insurance discovery analysts.

• Define team goals, monitor performance, and ensure alignment with departmental objectives.

• Develop and implement strategic plans for EDI and insurance discovery initiatives.

• Foster a culture of continuous improvement, innovation, and accountability

EDI Oversight:

• Oversee the monitoring, troubleshooting, and optimization of EDI transactions (e.g., 837, 835, 270/271, 276/277)

• Ensure accurate data exchange with internal systems and external trading partners

• Collaborate with IT and vendors to resolve complex EDI issues and implement enhancements

• Maintain documentation standards and ensure compliance with industry regulations

Insurance Discovery Management:

• Guide the design and execution of insurance verification and discovery processes

• Ensure data accuracy and integrity across systems through audits and quality checks

• Partner with payers and clearinghouses to resolve escalated coverage issues

• Support compliance and regulatory programs related to insurance data

Collaboration:

• Serve as the primary liaison between the EDI insurance team and Revenue Cycle, IT, Compliance, and Product

• Provide subject matter expertise for new product development and system integrations

• Lead training initiatives and knowledge-sharing efforts across the organization

Qualifications

• Bachelor's degree in Computer Sciences, Healthcare Administration, Information Systems, Business, or related field. Master's degree is beneficial
• 5+ years' experience in healthcare revenue cycle management, with emphasis on EDI, eligibility verification and insurance discovery operations , EDI formats and standards, X12, HL7
• 3+ years' experience in a leadership or supervisory role
• 5+ years' experience working with HIPAA regulated data, regulation and policy, payer-provider data interchange, and healthcare data standards
• 3+ years' experience working with healthcare management systems (e.g., Epic, Cerner) and clearinghouses
• 5+ years' experience with healthcare billing, coding, and insurance workflows

Additional Information

Benefits/Perks:

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays
• Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html

At Experian, our people and culture set us apart. We're deeply committed to creating an environment where everyone feels they belong and can excel. From inclusion and authenticity to work/life balance, development, wellness, collaboration, and recognition, we focus on what truly matters. Our people-first approach has earned us global recognition: World's Best Workplaces™ 2024 (Fortune Top 25), Great Place To Work™ 2025 in 26 countries, and Glassdoor Best Places to Work 2024, among others.

Want to see what life at Experian is really like? Explore Experian Life on social or visit our careers site.

Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience, and education. You will be also eligible for a variable pay opportunity.

Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal, state and local law, including protected veterans and individuals with disabilities. Innovation is an important part of Experian's DNA and practices, and our inclusive workforce allows everyone to succeed and bring their whole self to work. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.

#LI-Remote

This is a remote position.

Client-provided location(s): Flexible / Remote

Job ID: Experian-744000080663262

Employment Type: FULL_TIME

Posted: 2025-09-09T18:35:07