What are the responsibilities and job description for the EDI Specialist position at Tokio Marine HCC - Stop Loss Group?
Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.
TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk.
The primary objective of the role is to ensure the smooth transmission of EDI data between the organization and its customers and suppliers, ensuring timely and accurate data exchanges Responsible for implementing and supporting the day-to-day processing of EDI business application data between the company and various external accounts and trading partners. This position involves the management of all current and new EDI transactions. This role will work with the IT team to develop mapping requirements and translations, and to integrate transactions.
Key Responsibilities
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TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk.
- This role is located onsite in Kennesaw, GA*
The primary objective of the role is to ensure the smooth transmission of EDI data between the organization and its customers and suppliers, ensuring timely and accurate data exchanges Responsible for implementing and supporting the day-to-day processing of EDI business application data between the company and various external accounts and trading partners. This position involves the management of all current and new EDI transactions. This role will work with the IT team to develop mapping requirements and translations, and to integrate transactions.
Key Responsibilities
- Setup Trading Partners
- Work with trading partners to establish EDI connections, develop EDI maps, and test EDI transactions
- Maintain and implement EDI transaction sets with specific emphasis on Benefit enrollment and maintenance (834), Healthcare claim payment/advice (835), Healthcare claim (837)
- Troubleshoot communication issues when transmissions fail and escalate problems if necessary.
- Investigate, troubleshoot, and facilitate resolution of day-to-day issues.
- Execute and monitor daily inbound and outbound transactions to ensure a timely flow of transactions.
- Collaborate effectively with internal team and external accounts.
- Correct and re-translate any EDI documents that fail during translation.
- Learn and utilize the EDI front-end to setup trading partners and mapping.
- Responsible for documentation of all policies and procedures.
- Minimum 4 Year / Bachelors Degree in business, computer science, information systems, information technology, or equivalent experience.
- 2 Yearsof experience in a related field.
- Experience with applicable EDI software and systems including SQL Server and FTP
- Experience with enterprise resource planning and business process analysis
- Skilled at requirements gathering, problem analysis and problem solving.
- Comfortable making decisions and providing solutions to problems to team and superiors.
- Knowledge of insurance and claims processing, ACH, medical billing
- SQL Server 2019, SQL and ETL-Basic Knowledge
- Data warehousing concepts
- Scripting
- Microsoft 365 and Microsoft Teams
- Generous paid time off (PTO), 12 paid company holidays,
- 401(k) Retirement Plan with 6% company match.
- Health and dental insurance, and vision plan available.
- Company-provided long-term disability and life insurance.
- Opportunities for advancement in a successful and growing organization.
- Flexible work schedules and a great work/life balance.
- Paid Parental Leave.
- Volunteer Time Off.
- Enjoy casual dress and work in a modern, comfortable office with free parking.
- Hybrid work schedule
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