EDI Production Support Analyst - Remote Eligible

EDI Production Support Specialist

At CVS Health, we are building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary: As an EDI Production Support Specialist, you'll serve as a key resource for both internal and external customers, ensuring the seamless operation and troubleshooting of EDI transactions. You'll combine technical expertise with strong communication and problem-solving skills to deliver high-quality support and drive continuous improvement.

Responsibilities:

• Respond promptly and professionally to inquiries from internal and external customers.
• Track requests, maintain status reports, and investigate claim/file failure trends.
• Configure EDI setups and support implementation leads during testing phases.
• Attend meetings with clients to discuss claim/file failures, conduct root cause analysis, and provide education as needed.
• Assist clients with regression testing and EDI connection setup for member rosters and provider files.
• Review detailed technical designs for department projects and serve as an end user during testing.
• Prepare clients for production, assist with upgrades or changes to communication protocols, formats, or software.
• Create and update documentation to ensure clarity and accuracy.

Required Qualifications:

• 1-2+ years of experience in EDI production support, including troubleshooting and client-facing coordination.
• In-depth knowledge of EDI transactions, especially 837P, 837I, 837 Outgoing, and 999 files.
• Hands-on experience testing flat files, XML, standard X12 (837P, 837I, 837 Outgoing, 999), UB92, and HCFA1500 transactions.
• Ability to use crosswalks, HIPAA Implementation Guides, and requirements documents to validate data mapping.
• Full understanding of privacy rules and HIPAA compliance.
• Strong analytical and problem-solving abilities.
• Excellent communication skills, able to translate technical information for business users.
• Highly self-motivated, organized, and able to prioritize tasks in a high-pressure environment.
• Strong customer service orientation and attention to detail.

Preferred Qualifications:

• Background in healthcare or claims processing experience.
• Experience with Aetna claims processing systems.

Education:

• High School diploma/GED and equivalent work experience.
• Associates degree or Bachelor's degree is preferred.

Anticipated Weekly Hours:

40

Time Type:

Full time

Pay Range:

$46,988.00 - $122,400.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.