EDI Support Specialist, Tier II

Join Claim.MD: Simplifying Healthcare Through Innovation and Compassion

Claim.MD is a leading national electronic healthcare clearinghouse, supporting thousands of providers, payers, and software vendors across the country. Our mission is to simplify and optimize the flow of medical claims and related data, enabling healthcare organizations to operate more efficiently and deliver better patient outcomes. We are dedicated to streamlining healthcare transactions and improving operational efficiency for our users. Driven by a strong commitment to innovation and excellence, we seek individuals who are passionate about making a tangible difference in the healthcare industry.

Why You Will Love Working Here: 

Collaborative Culture: Work alongside a team that values open communication, mutual respect, and shared success. 

Growth Opportunities: We invest in your professional development, offering training and pathways to advance your career. 

Flexible Work Environment: Enjoy the benefits of a work-from-home environment that supports work-life balance. 

Meaningful Impact: Contribute to a product that directly improves the efficiency of healthcare providers nationwide. 

Role Summary: 

The EDI Support Specialist, Tier II role provides support via the telephone, Claim.MD web/support portal, virtual meetings, and email. EDI Support Specialist, Tier II team members are responsible for efficiently and accurately resolving support cases related to clearinghouse and payer issues. An EDI Support Specialist, Tier II must have in-depth, working knowledge of ANSI X12 Version 5010 EDI transactions, medical billing workflows, and have experience working in a help desk/support environment. This role requires strong applied knowledge of healthcare claims workflows, including claim edits, rejections, and remittance processes.

Your primary focus will be responding to and resolving support tickets within defined SLAs, with a deep emphasis on investigating EDI issues associated with claims, eligibility and ERAs.

You will bring precision and efficiency to every client interaction, working independently and troubleshooting issues that can be routine or urgent while also supporting your teammates with guidance and documentation improvements. This role is ideal for someone who thrives in a fast-paced, data-driven environment and is ready to apply their EDI expertise to real-world problems within the healthcare industry through strong technical troubleshooting, deep domain knowledge, and clear communication with both clients and internal teams.

This is a healthcare operations support role, not a technical help desk or developer position. Prior experience with medical billing, payer-provider communications, clearinghouse submissions, or healthcare EDI transactions is required.

Essential Functions and Responsibilities: 

The following duties are considered essential to the successful performance of this position. These tasks are central to supporting Claim.MD’s users, maintaining compliance, and ensuring operational continuity. EDI Support Specialist, Tier II typically manages a high daily ticket volume - averaging around 100-105 tickets per day. As we scale the team and onboard new team members, this volume is expected to stabilize to 60-70 tickets per day. Candidates should feel comfortable navigating a fast-paced, high-volume support environment, with strong prioritization skills and a collaborative mindset. 

We are committed to rebalancing workloads as we scale, and are in the process of expanding the support team to create long-term stability and growth opportunities for our team members.

Manage high-volume support queues: initial target 100–105 tickets/day, scaling down to 60–70 as the team grows.

Receive inbound calls; create, update, and actively resolve support tickets while providing a professional and responsive experience.

Warm-transfer calls to appropriate team members when necessary to ensure timely resolution and continuity of support. 

Accurately document all user interactions in the ticketing system to support compliance, communication, and audit requirements. 

Navigate and utilize a variety of internal systems efficiently; demonstrate the ability to quickly learn new tools and workflows. 

Communicate clearly and professionally with internal teams and external users in both verbal and written formats. 

Prioritize and manage multiple tasks in a high-volume support environment while maintaining strong attention to detail. 

Remain calm and solutions-focused when handling challenging or time-sensitive inquiries. 

Collaborate with other team members and departments to support cross-functional resolution and knowledge sharing. 

Comply with all internal protocols and applicable inquiry audit standards, including those related to data privacy and security. 

Contribute to additional tasks, projects, or initiatives as assigned by leadership. 

Required Skills and Competencies:

Advanced EDI Knowledge - Strong understanding of EDI ANSI X12 formats such as 835, 837P/837I/837D, 270/271, 276/277, 277CA; applies healthcare use cases to problem-solving.

Analytical Troubleshooting - Ability to diagnose complex issues and recommend practical, scalable solutions. 

Client Communication - Effectively explains clearinghouse, payer, and billing-related issues in both verbal and written formats.

Professional Judgement Under Pressure - Handles high-stakes or time-sensitive issues calmly and effectively by applying technical knowledge, sound judgment, and thoughtful communication. 

EDI Compliance and Data Stewardship - Maintains up-to-date knowledge of HIPAA, payer requirements, and data handling protocols to ensure regulatory compliance and safeguard sensitive information. 

Required Experience: 

Education – Bachelor’s Degree in a relevant field or equivalent professional experience.

Healthcare EDI Transactions – Minimum 3 years of experience working with 835, 837P/I/D, 270/271, 276/277, and 277CA transaction sets.

Medical Claims Processing – Minimum 2 years of experience in healthcare claims workflows or revenue cycle support.

Support Experience – Minimum 2 years in a healthcare customer support or provider services environment.

Practice Management Systems – Minimum 2 years of experience using PM software, clearinghouse portals, or billing platforms.

Compliance and Privacy – Minimum 2 years of experience working within HIPAA-regulated environments.

Problem Solving Under Pressure – Demonstrated ability to manage high-volume requests calmly and effectively.

Preferred Skills and Competencies: 

Proficiency in ICD, CPT, and HCPCS medical coding systems 

Ability to accurately interpret Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) 

Familiarity with healthcare data transmission formats, including SFTP, API, and print image files 

Experience in verifying insurance eligibility and benefits 

Demonstrated skill in identifying and resolving issues using research and critical thinking

Additional Skills that are a Plus: 

Regular Expressions and/or XML, CSV, XLS, XLSX, JSON File Formats

Spanish proficiency 

Work Environment and Expectations:

To be considered for this position, applicants must currently reside in the United States and be authorized to work on a full-time basis. Claim.MD is unable to sponsor or take over sponsorship of employment visas at this time. 

Candidates must be willing to submit to a pre-employment background check conducted in accordance with applicable federal, state, and local laws. Employment at Claim.MD is contingent upon the successful completion of this background screening process.

This is a fully remote position working Monday-Friday. 

This role operates across all U.S. time zones; however, Pacific Time (PST) availability is preferred to best support current team needs. 

Employees are expected to work from a quiet, dedicated and secure home workspace (mobile or on-the-go work is not supported for this role). 

Company-issued desktop equipment will be provided.

Employees must be able to sit and use a computer and phone for extended periods. 

Employees are expected to maintain a reliable high-speed internet connection and to be available during core collaboration hours

Claim.MD is committed to creating an accessible and inclusive workplace. In accordance with the Americans with Disabilities Act (ADA), we provide reasonable accommodations to qualified individuals with disabilities. If you require an accommodation during any stage of the application or employment process, please contact Claim.MD’s HR Department.

We are happy to provide support to ensure equal opportunities throughout the hiring and onboarding experience.

E-Verify Participation

Claim.MD participates in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees. As a participant in E-Verify, Claim.MD will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s Form I-9 to confirm work authorization.

Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Claim.MD will not use E-Verify to pre-screen job applicants or to reverify current employees and will not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status during the E-Verify process.

For more information about E-Verify, please visit www.e-verify.gov.

What We Offer: 

Compensation Range - $60,000- $65,000 annually, based on experience and geographic location. Final compensation will be determined in accordance with state-specific pay transparency requirements. 

Comprehensive Benefits Package - Including health, dental, and vision coverage, as well as retirement savings plan. 

Internet Reimbursement - Up to $100 per month for high-speed internet required for the role. 

Career Growth and Development - Opportunities for skill-building, advancement, and continuous learning. 

Work-Life Balance - Flexible schedules and a supportive, collaborative work environment.

Inclusive Company Culture - A commitment to diversity, equity, and inclusion in all our practices. 

Employee Wellness - Programs and resources focused on your overall well-being, including mental and physical health support. 

Work Remotely - Opportunity to work remotely. 

Paid-Time Off - Two weeks of paid time off, in addition to a generous holiday schedule, to support your work-life balance and personal well-being.

Commitment to Inclusion:

At Claim.MD, we believe in a skills-first approach to recruitment and employment. This means focusing on what you can do and how you can grow, rather than traditional metrics alone. We are committed to adhering to anti-exclusion practices, removing barriers to access, and enhancing opportunities for all individuals based on merit and potential. 

Your skills, experiences, and perspective are valuable - and we want to empower you to make your mark here with us. 

Equal Employment Opportunity

Claim.MD is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees and applicants regardless of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected status.

Interested in applying? Submit your application. We look forward to welcoming you!