EDI Integration Solution Architect

Integration Solution Architect (EDI) - Insurance or Healthcare / Payer

Lake Forest, IL (Hybrid)

Job Summary

Integration Solution Architect with deep insurance or healthcare payer EDI experience for a contract engagement supporting a U.S.-based insurance client. This is an architecture-plus-hands-on role: the client is standing up new eligibility (834), claims (837), and real-time eligibility (270/271) integration flows to an external partner platform. Their integration flows span Mainframe/claims source systems, ACE enrichment, Edifecs EDI processing, and secure file transfer (SFTP) to the partner, including repriced-claim return processing. This position is open to candidates based in the United States or Canada. Candidates available for hybrid commute model (3 days/week) to the north suburbs of Chicago will have a significant advantage.

Key Responsibilities

• Own the end-to-end technical architecture for the EDI/partner integration, defining current-state and target-state data flows
• Design integration solutions for 834, 837, and 270/271 transactions, including full-file/change-file eligibility processing and repriced-claim return handling
• Define interfaces and ownership boundaries across mainframe/claims source systems, ACE enrichment, Edifecs mapping/validation/EDI generation, and GlobalScape/SFTP transfer
• Determine authoritative sources for member, eligibility, plan, claims, and benefit data, and design transformation/enrichment rules against X12 requirements
• Define mapping, validation, routing, acknowledgement (999/TA1/277CA), exception-handling, and reconciliation requirements within Edifecs
• Design secure file-transfer architecture and establish end-to-end transaction traceability from source system through partner and back
• Produce architecture diagrams, interface specifications, field-level mapping documents, and technical design documentation
• Lead technical discussions across client, partner, and onshore/offshore delivery teams; support SIT, end-to-end testing, UAT, and production stabilization
• Surface integration dependencies, risks, assumptions, and open design questions early - including unresolved items like accumulator delivery mechanism

Required Skills & Experience

• 10+ years of IT experience, including 5+ years in healthcare payer EDI architecture/design
• Hands-on Edifecs experience on real production implementations (mapping, validation, transformation) - not just platform exposure
• Deep working knowledge of ANSI ASC X12 / HIPAA 5010 transactions, especially 834, 837 (professional and institutional), and 270/271
• Experience integrating EDI platforms with mainframe and enterprise claims/eligibility systems
• Experience with enrichment/middleware integration platforms (e.g., IBM ACE) and SFTP/MFT solutions (GlobalScape or equivalent)
• Working knowledge of REST/SOAP API integration design
• Strong grounding in payer domains: enrollment, eligibility, benefits, claims, claim repricing, provider data, and accumulators
• Strong SQL/data-analysis skills for validating source, transformed, and target data
• Demonstrated ability to produce solution architecture diagrams and detailed interface/technical designs
• Excellent communication skills, comfortable leading discussions across business, architecture, vendor, and client stakeholders
• Experience with Edifecs XEngine/XEServer/Smart Trading or comparable Edifecs platforms
• Experience integrating legacy mainframe/DB2 claims systems with modern integration platforms
• Familiarity with claims/eligibility platforms comparable to Claimfacts, MIDS, or ACE
• Experience with healthcare repricing/vendor integrations and EDI acknowledgement patterns (999, TA1, 277CA)
• Understanding of HIPAA/PHI security, auditability, and healthcare data-retention requirements