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EDI Specialist - Irvine, CA

UnitedHealth Group

Irvine, CA
Job Code:
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Job Details

EDI Specialist - Irvine, CA(Job Number:709453)

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)


The EDI Specialist is responsible for facilitating all activities between the provider, clearinghouse and IT in order to establish connectivity for submitting claim files.  They will work closely with Network Management, Contracting and Claims to ensure all appropriate data elements are transmitted for claims payment.  They will also be responsible for creation and maintenance of associated companion guides and mapping business rules as well as monitoring throughput on all submitters and converting paper submitters to EDI. 


Primary Responsibilities:

  • Act as a liaison between the provider and IT to set-up providers submitting new claim files

  • Coordinate set-up activities with selected clearinghouse to ensure proper steps are followed for an effective transition

  • Validate post-implementation submissions to ensure file integrity and established business rules are applied

  • Perform an outreach process to determine proper EDI submission method and customize based upon provider’s business needs

  • Identify providers who submit paper claims to target for EDI implementation

  • Publish monthly reports to illustrate EDI submission rates and related metrics

  • Investigate identified claims in-load discrepancies and work with related billers or vendors to remediate issue



Job Provider Reimbursement
Primary Location US-CA-Irvine
Other Location US-California, US-CA-Santa Ana
Organization Monarch
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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