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HealthEdge

Core administrative systems for health plans

Healthcare IT Technical Operations Associate 3

IT OperationsConfirmed live in the last 24 hours
Full-timeRemote in USA$70k - $88k /yr

About the Job

Requirements

  • A bachelor's degree in Computer Science, Information Technology, or a related field is required.
  • A minimum of 3–4 years of experience in application support, technical operations, or production support roles is required.
  • Experience with healthcare platforms such as HealthEdge, Facets, or QNXT is required.
  • Experience with healthcare data formats such as EDI X12 (270/271, 276/277, 834, 835, 837) is required.
  • The candidate must be able to communicate clearly with external customers.
  • Experience with production monitoring tools for investigation and support is required.
  • Experience with ITSM tools such as Jira or ServiceNow is required.
  • Hands-on experience with SQL for data validation, log analysis, and reconciliation queries is required.
  • A solid understanding of incident management, SLA tracking, and escalation processes is required.
  • Familiarity with monitoring tools such as Dynatrace is required.
  • Basic scripting knowledge for log review or automation is required.
  • Awareness of ITIL practices is required.
  • Understanding of US healthcare workflows, including claims processing, member enrollment, and provider interactions, is required.
  • Familiarity with HIPAA compliance and healthcare data security standards is required.
  • The candidate may be required to undergo a pre-employment criminal background check.

Responsibilities

  • Investigate and triage job failures, fallouts, and reprocessing requests raised by L1.
  • Perform initial analysis using application logs, database queries, monitoring tools, and upstream/downstream dependency checks to support root cause identification.
  • Work alongside L3, product, and other stakeholders to drive root cause identification and resolution, providing analysis, context, and coordination throughout.
  • Execute data correction and reprocess failed or fallout records according to standard procedures once a fix or instruction is available.
  • Validate outcomes after reprocessing and confirm successful completion.
  • Support implementation of preventive actions for recurring failures in coordination with L3 and product teams.
  • Perform record count reconciliation between input and output files, tables, and messages, as well as detailed reconciliation beyond basic counts as defined in the runbook.
  • Execute periodic reconciliations across all interfaces to ensure end-to-end data integrity.
  • Complete ad hoc customer requests in a timely manner.
  • Analyze and resolve record count mismatches, data mismatches, duplicates, missing transactions, and out-of-balance conditions.
  • Define and enhance reconciliation control mechanisms and validation checkpoints.
  • Maintain reconciliation logs and audit trails for all data correction and reprocessing activity.
  • Analyze inbound and outbound interface issues across systems.
  • Coordinate with external vendors, trading partners, and upstream/downstream teams on file failures, format issues, delays, and data discrepancies.
  • Provide functional guidance to L1 for complex monitoring and triage scenarios.
  • Review L1-raised tickets for completeness and drive faster resolution.
  • Contribute to runbook and SOP updates so recurring patterns are easier for L1 to detect, report, and route.
  • Publish periodic reports on reconciliation status, fallout and reprocessing volumes, and SLA performance.
  • Document and communicate open reprocessing activities, pending reconciliations, and business-critical risks during shift handover.
  • Identify recurring failures and support permanent fixes and process improvements.
  • Recommend automation opportunities for reconciliation and monitoring activities.
  • Contribute to best practices and process standardization across interfaces.

About the Company

HealthEdge

Core administrative systems for health plans

HealthEdge provides software for healthcare payers, delivering core administrative systems and care-coordination tools for health plans. Its flagship HealthRules Payor uses business rules and workflows to automate claims processing, member services, and provider-network management, integrating with existing payer systems to streamline operations. The company differentiates itself with a 11-year Gartner Sample Vendor recognition, proven claims efficiency, and partnerships like CitiusTech, offering an end-to-end solution that covers licensing, implementation, and ongoing support. Its goal is to help health plans operate more efficiently, improve care coordination, and thrive under value-based reimbursement.

Company size
1,001-5,000
Company stage
Late Stage VC
Total funding
$97.8M
Headquarters
Burlington, MA
Founded
2004

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