Feb 2020 – Jul 2021 · 1 yr 5 mos · Bengaluru, Karnataka, India · On-site

• EDI File Mapping & Benefits Integration Specialist
• Specialized in file mapping and eligibility data exchange for health and voluntary benefits carriers.
• Key Responsibilities & Achievements:
• Mapped EDI files tailored to client-specific account and group structures, ensuring accurate alignment with internal and external systems.
• Created flat files in both fixed-length and comma-separated formats for seamless data transmission.
• Developed COBRA files and 834 Benefit Eligibility files, including voluntary plan data for carriers such as Cigna, Delta Dental, Mutual of Omaha, and VSP.
• Authored test plans and executed validation steps to ensure data integrity and compliance with carrier specifications.

Aug 2019 – Feb 2020 · 6 mos · Bengaluru, Karnataka

• EDI Analyst – Logistics & Supply Chain Domain
• Oversaw global EDI mapping and support using SAP, Liaison (OpenText), and SQL, with a focus on transportation and logistics operations.
• Key Responsibilities & Achievements:
• Managed EDI operations within SAP and Liaison (OpenText) environments, using SQL for data handling and issue resolution.
• Designed and maintained global EDI maps for logistics processes, including ANSI X12 (850, 855, 860, 865) and EDIFACT transactions.
• Supported day-to-day EDI issues, providing real-time troubleshooting and ensuring continuity in supply chain data flow.
• Worked closely with the onshore team to gather and refine business requirements, translating them into technical EDI solutions.
• Led a team of EDI specialists, managing task allocation, tracking deliverables, and driving resolution of high-priority issues.
• Applied domain expertise in transportation, logistics, and supply chain to ensure EDI transactions aligned with operational workflows.
• Coordinated with external partners and internal systems teams to ensure successful deployment and testing of EDI solutions.

Nov 2016 – Feb 2020 · 3 yrs 3 mos · Bangalore, Karnataka

• EDI Project Lead / Business Analyst
• Led end-to-end EDI project delivery, from requirements to implementation, including team setup, client engagement, and solution development.
• Key Responsibilities & Achievements:
• Gathered and documented business requirements for new EDI initiatives, creating BRDs, FSDs, use cases, and prototypes to align with client expectations.
• Delivered live demos and walkthroughs to clients, securing alignment and sign-off on proposed solutions.
• Managed multiple concurrent projects, balancing priorities and coordinating with cross-functional stakeholders.
• Established a new EDI team and built EDI processes from the ground up, defining best practices, standards, and governance.
• Utilized EDI-HQ and Babelway software to develop, test, and generate EDI files tailored to project-specific requirements.
• Acted as a central point of contact across business, technical, and client teams to ensure seamless communication and execution.

Jun 2014 – Jul 2016 · 2 yrs 1 mo

• EDI Business Analyst / EDI Support Specialist
• Led EDI setup, mapping, and support across multiple healthcare and insurance platforms, ensuring HIPAA-compliant, timely, and accurate data exchange.
• Key Responsibilities & Achievements:
• Designed and implemented EDI setup and mapping templates for both inbound and outbound files, including ANSI X12 formats (837P/I, 835, 834, 278, 997, 999, 850, 855, 856, 820) and flat files (including 1000-byte formats).
• Collaborated with trading partners, clients, brokers, and internal teams to configure EDI workflows, troubleshoot issues, and streamline onboarding.
• Played a lead Business Analyst role in the pricing logic design and implementation for Columbia Health Plan (USA), translating complex requirements into actionable development plans.
• Provided Level 1 and Level 2 EDI support, resolving issues related to data transmission, encryption, formatting, and transaction compliance.
• Authored and maintained business documentation, including BRDs, FSDs, process flows, and prototypes; presented documentation to stakeholders and obtained approvals.
• Managed secure data transmission using FTP/SFTP protocols, Filezilla, and PGP encryption; familiar with remote desktop environments for real-time support and troubleshooting.
• Acted as liaison between clients and internal teams (development, QA, implementation), facilitating smooth UAT, defect resolution, and production deployment.
• Coordinated end-to-end testing, including functional testing and client UAT, to ensure EDI transactions met business and technical specifications.
• Strong working knowledge of HIPAA regulations and ANSI X12 standards across healthcare domains.
• Performed EDI transaction validation and verification to ensure accurate integration between systems and trading partners.

Feb 2014 – Jun 2014 · 4 mos

• Key Responsibilities & Achievements:
• Managed the full transition of EDI transactions from ICD-9 to ICD-10, including gap analysis, testing, and validation of HIPAA-compliant files such as 837, 835, 278, 270, 271, and 834.
• Created and maintained trading partner agreements and configuration setups for both ICD-9 and ICD-10 under 5010 parallel processing.
• Conducted in-depth ICD-9/ICD-10 gap analysis and prepared detailed mapping documentation for key transactions.
• Oversaw daily claim processing operations, including uploading and validating 837 files in the database.
• Troubleshot complex claim processing issues across providers and hospitals; collaborated cross-functionally to resolve root causes and implement solutions.
• Facilitated user interviews and requirements gathering for a new health insurance product; translated business needs into technical specifications.
• Tested HIPAA transactions for dual version support (4010 and 5010) and ensured database-to-file element consistency.
• Collaborated closely with developers to enhance and standardize the ETL process supporting the Network Health system.
• Set up new trading partners via sFTP and database configuration, ensuring secure and accurate data exchange.
• Guided vendors through HIPAA compliance alignment by analyzing existing client systems and providing implementation support.
• Participated in risk assessment sessions; identified claims processing bottlenecks and proposed scalable, compliant workarounds.
• Conducted workflow and process analysis to uncover inefficiencies and document improvement areas.
• Worked across functional teams to unify business and technical specifications for seamless integration.

Apr 2012 – Jun 2012 · 2 mos · Jaipur, Rajasthan

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