Job description

Job Title: EDI Claims Implementation Specialist Location: Remote (U.S.) Employment Type: Contract (W2 through ZipStaff — No C2C or 1099) About the Opportunity: ZipStaff is seeking an EDI Claims Implementation Specialist to support a system migration for a Massachusetts Medicaid client at a major managed care organization. You will bridge inbound claims, adjudication-system impacts, and downstream encounter reporting as the client moves from one claims platform to another. This is a hands-on implementation seat focused on healthcare claims — not a general EDI developer role and not a pure outbound reporting role. What You’ll Do: • Support migration of a Massachusetts Medicaid client from one claims system to another. • Own inbound / pre-adjudication work: 837 claim ingestion from providers, including EDI intake, mapping, validation, and routing into the claims platform. • Support post-adjudication 837 encounter reporting: extraction, mapping, validation, submission, acknowledgments, and reconciliation. • Assess and address impacts to adjudication, eligibility, and accumulator processing during the transition. • Validate claims and encounter data across platforms and drive defect resolution through cutover. • Partner with functional and technical teams to keep the migration on track. Required Qualifications: • 5+ years hands-on EDI claims and implementation experience in healthcare insurance. • Strong inbound claims experience (preferred over outbound) covering 837 claim ingestion, intake, mapping, validation, and routing. • Post-adjudication experience with 837 encounter reporting, including extraction, mapping, submission, acknowledgments, and reconciliation. • Recent experience (last 4 years ) in healthcare insurance claims, eligibility, and accumulators. • Proven experience supporting system migrations or implementations where claims processing and encounter reporting moved between platforms. • Must be legally authorized to work in the United States without sponsorship now or in the future. Preferred Qualifications: • MassHealth or Medicaid experience. • Familiarity with MassHealth 837 encounter reporting requirements. • Experience with both inbound and outbound claims (team already has some outbound expertise). • Behavioral health or managed care background. Benefits: • Health Insurance. • Dental Insurance. • Vision Insurance. • 401(k) + 401(k) matching. • Paid time off. • Referral Program. About ZipStaff ZipStaff partners with leading organizations to connect skilled technology professionals with high-impact contract opportunities. We focus on quality matches, clear communication, and long-term success for candidates and clients. To apply, submit your resume highlighting 837 inbound claims work you owned, encounter reporting you supported, and any migration or implementation projects. Non-healthcare EDI or outbound-only experience will not be considered. Pay: $58 - $60 per hour

Requirements

Must-haves

Job Title: EDI Claims Implementation Specialist
Location: Remote (U.S.)
Employment Type: Contract (W2 through ZipStaff — No C2C or 1099)
Support migration of a Massachusetts Medicaid client from one claims system to another.
Own inbound / pre-adjudication work: 837 claim ingestion from providers, including EDI intake, mapping, validation, and routing into the claims platform.
Support post-adjudication 837 encounter reporting: extraction, mapping, validation, submission, acknowledgments, and reconciliation.
Assess and address impacts to adjudication, eligibility, and accumulator processing during the transition.
Validate claims and encounter data across platforms and drive defect resolution through cutover.
Partner with functional and technical teams to keep the migration on track.
5+ years hands-on EDI claims and implementation experience in healthcare insurance.
Post-adjudication experience with 837 encounter reporting, including extraction, mapping, submission, acknowledgments, and reconciliation.
Recent experience (last 4 years ) in healthcare insurance claims, eligibility, and accumulators.
Proven experience supporting system migrations or implementations where claims processing and encounter reporting moved between platforms.
Must be legally authorized to work in the United States without sponsorship now or in the future.

Nice-to-haves

Strong inbound claims experience (preferred over outbound) covering 837 claim ingestion, intake, mapping, validation, and routing.
MassHealth or Medicaid experience.
Familiarity with MassHealth 837 encounter reporting requirements.
Experience with both inbound and outbound claims (team already has some outbound expertise).
Behavioral health or managed care background.

Application prep

Use the role’s language and application details while tailoring your materials.

Platform: betterteam
Effort: medium

Benefits

Benefits detected in the listing.

Health Insurance

Dental

Vision

401(K)

Paid Time Off