Find work in the United States.

A simpler way to find your next job.

Jobs in the United States

25+ jobs

Save this search

Added 12 mins ago
CH
Manager Facilities - Full Time - Days
Cobb Hospital, Inc.
Austell, GA
- Full-time
…facilities are at a desired level. b. Facilitates interior signage program if applicable by coordinating with department management in ordering replacement signage for new construction and…
Added 47 mins ago
DELI/CLERK
The Kroger Co.
Happy Valley, OR
Deli Clerk assists the department manager in reaching sales and profit goals established for the department and monitors all established quality assurance standards.
Added 47 mins ago
DELI/CLERK
The Kroger Co.
The Dalles, OR
Deli Clerk assists the department manager in reaching sales and profit goals established for the department and monitors all established quality assurance standards.
Added 48 mins ago
BAKERY/CLERK
The Kroger Co.
Virginia Beach, VA
Bakery Clerk assists the department manager in reaching sales and profit goals established for the department and monitors all established quality assurance standards.
Added 48 mins ago
DELI/CLERK
The Kroger Co.
Meridian, ID
Deli Clerk assists the department manager in reaching sales and profit goals established for the department and monitors all established quality assurance standards.
Added 53 mins ago
Associate Director, Cloud Network Engineer
S&P Global
Princeton, NJ
Global Network Services is a high-impact, globally distributed engineering team responsible for designing, securing, and automating S&P Global's cloud and hybrid network infrastructure. The…
Added 55 mins ago
Safety and Occupational Health Manager
Minot AFB Civilian Personnel
MINOT AFB, ND
Added 1 hour ago
AM
2027 Spring Project Manager Co-op (Billerica, MA)
Applied Materials, Inc
Billerica, MA
- $31 to $41 USD / hour
Ensures that all phases of project, program and/or process development are documented and that information required in other functional areas is reported, disseminated, or transferred, as…
Added 1 hour ago
Alternative Project Engineer
State of Montana
Helena, MT
Added 1 hour ago
Construction Engineer VII
Fluor
Hawesville, KY
Coordinate the preparation and implementation of the project quality program when the quality function is the responsibility of the construction engineering department; report the status of…
Added 1 hour ago
Construction Engineer VII
Fluor
Hawesville, KY
Coordinate the preparation and implementation of the project quality program when the quality function is the responsibility of the construction engineering department; report the status of…
Added 1 hour ago
Business Intelligence and Analytics Manager, Reporting and Data Analytics
Machinify
La Grange, KY
The Healthcare Business Intelligence and Analytics (BIA) Manager owns client reporting, compliance reporting, and performance analytics spanning various programs. This position will…
Added 1 hour ago
A
Reliability Automation Manager
Actalent
Erlanger, KY
- $69.71 USD / hour
Develop and improve the preventive and predictive maintenance program for all equipment.
Added 1 hour ago
GB
Project Management Intern - Lexington KY 2027
Gilbane Building Company
Lexington, KY
- $7.25 USD / hour
Currently enrolled in Engineering, Construction Management, Real Estate, or similar program
Added 1 hour ago
O
Principal Technical Program Manager
Oracle
Reston, VA · Seattle, WA
- $91,000 to $209,500 USD / year
…engagement with a wide range of stakeholders, including design, engineering, operations, supply chain, external vendors, and network delivery…
Added 2 hours ago
Manager Mission Assurance 2
Northrop Grumman
Redondo Beach, CA · Redondo Beach
…driving continuous improvement across the supply chain to achieve program quality objectives and customer satisfaction. This position may require up to 80% of direct work for supported…
Added 2 hours ago
Manager Supply Chain Programs - Level 1
Northrop Grumman
Dulles, VA · Gilbert, AZ · Dulles · Gilbert
Serve as the primary supply chain focal point for assigned Program Management Offices (PMOs), ensuring all supply chain commitments are met through proactive coordination across…
Added 2 hours ago
Program Operations Manager
Raydar
Washington, DC
Raydar is recruiting for this role on behalf of our client. Act as the accountable program owner for customer engagements, partnering with a technical lead and a team of engineers. Convert…
Added 2 hours ago
Process Engineer
Saint-Gobain
MILAN, OH
…as a liaison between all the major departments: production, engineering, maintenance, logistics and…
Added 2 hours ago
Senior Security Manager, Next Generation Programs
GE Aerospace
Evendale, OH
Serve as the primary security interface with Department of Defense/Intelligence Community security offices, Program Managers, Engineering, IT, Supply Chain, and Quality.
Added 2 hours ago
Staff Engineer - Turbine Aerodynamics
GE Aerospace
Evendale, OH
The Aerodynamics Staff Engineer will report to the Turbine Aerodynamics Manager and be responsible for leading the design of GE Aerospace’s next generation of turbine components and…
Added 2 hours ago
Senior Staff Engineer - Turbine Aerodynamics
GE Aerospace
Evendale, OH
…Senior Staff Engineer will report to the Turbine Aerodynamics Manager and be responsible for leading the design of GE Aerospace’s next generation of turbine components and associated…
Added 2 hours ago
CC
Project Manager IV-Nursing Administration
Cleveland Clinic
Independence, OH
- $84,200 to $128,412.5 USD / year
As Program Manager IV, you will manage all aspects of assigned projects and serve as a single point of contact. In this role, you will lead and manage multiple medium- to large-sized…
Added 2 hours ago
Engineering Operation Technician II, AWS DC Operations Engineering (DCEO)
Amazon
Hilliard, OH
Join our dynamic team and become a critical guardian of technological infrastructure! As a Data Center Engineering Technician, you'll play a pivotal role in maintaining the heartbeat of…
Added 2 hours ago
Program Manager IV
General Atomics
Beavercreek, OH
This position typically reports to a senior program manager and is responsible for the planning, managing and technical performance of one or more established engineering program(s)…

Fallon Health

Manager, EDI

Worcester, MA, United States

$130,000 to $135,000 USD / year

Apply About employer

Applications open in a new tab.

Job details

Pay: $130,000 to $135,000 USD / year
Education: Bachelor’s degree
Experience: 7+ years of experience in the operational environment of a Managed Care Organization (MCO).
Posting language: English
Posted: Oct 26, 2026

Original job description

Overview

About us:

Fallon Health is a company that cares. We prioritize our members - always - making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs - including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly) - in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Manage, plan, and direct the daily operations of the EDI Department to ensure accurate, timely, and efficient execution of all EDI functions across Fallon Health. Accountable for ensuring the EDI team operates at peak effectiveness, delivering consistently high standards of accuracy, timeliness, and reliability in support of organizational goals. Plays a critical role in communicating the business and operational impacts of technical tasks and issues, ensuring downstream effects are clearly understood by all stakeholders**.

Oversee the end‑to‑end EDI lifecycle for the organization, including tracking all incoming and outgoing EDI files, monitoring and researching failed or unsuccessful transmissions, identifying trends or recurring issues, and coordinating resolution with internal teams and external trading partners. Serve as a point of escalation for provider & vendor concerns related to submission discrepancies and lead initiatives to increase the adoption of electronic submissions among contracted providers and clearinghouses**.

Responsible for the training, development, and performance management of EDI staff, as well as the documentation and maintenance of all EDI‑related policies and procedures. Collaborate closely with internal and external customers to meet service-level expectations, fulfill operational commitments, and ensure deadlines are consistently met.

Responsibilities

Primary Job Responsibiliites

Operational & EDI Oversight

Manage, oversee, and monitor all EDI team operations and functions.
Ownership of EDI SLAs and KPIs (throughput, error rates, turnaround time)**
Support for audits (internal/external) related to EDI or claims **
Participation in enterprise change management / release management **
After‑hours escalation or on‑call responsibilities **
Oversee the end‑to‑end EDI process, including tracking all incoming and outgoing files, claim counts, fatal edits, and processed files.
Monitor and research unsuccessful transmissions; identify trends and coordinate issue resolution with internal departments and external partners.
Provide oversight of EDI claims reconciliation processes to ensure accuracy and completeness.
Oversee monitoring of Trading Partners in testing phases, including weekly status updates.
Manage all communications related to EDI submission issues requiring troubleshooting with internal teams and contracted providers.
Lead continuous quality improvement initiatives across EDI processes.

Systems, Testing & Technology

Responsible for testing and signoff of all Edifecs and QNXT system upgrades or changes related to electronic submissions.
Accountable for validating new and updated technology applications against existing EDI logic and communicating impacts and results to appropriate departments.
Oversee implementation and maintenance of HIPAA transaction sets (270/271, 276/277, 278, 820, 835, 837I, 837P).
Ensure security setup and access controls for online tools, including Provider and Employer Tools.

Compliance & Regulatory

Monitor, implement, and ensure compliance with State and Federal regulations, including HIPAA Privacy and Security standards and CAQH CORE requirements.
Ensure EDI operations support regulatory, audit, and compliance expectations.
Staff Management & Development

Assign, prioritize, and monitor work to ensure timely and accurate completion.

Ensure staff are properly trained, understand job and organizational expectations, and receive corrective or remedial action when necessary.
Provide ongoing performance feedback and conduct annual performance reviews.
Review and approve time and attendance records in accordance with company standards.
Respond to staff and HR‑related matters as needed.
Foster a cooperative team environment by:

Communicating department and company initiatives

Resolving staff issues
Encouraging constructive feedback
Adjusting procedures to improve efficiency

Training & Documentation

Responsible for training all EDI staff and providing training support to other departments as needed.
Ensure documentation and maintenance of all EDI team policies, procedures, and workflows.

Leadership, Communication & Representation

Act as liaison between EDI, IT, Configuration, and other internal departments to resolve day‑to‑day operational issues.
Represent the EDI team in meetings with internal and external customers, including clearinghouse vendors.
Administer and manage relationships with EDI clearinghouse vendors.
Facilitate departmental meetings and deliver presentations to senior leadership as required.

Strategic & Performance Measures

Lead initiatives to increase the volume of providers submitting claims electronically, supporting organizational performance measures for EDI adoption.
Drive improvements to EDI auto‑adjudication rates, with annual targets defined through departmental strategic objectives.

Qualifications

Qualification requirements

Education

Bachelor’s Degree required.

Master’s degree or foreign equivalent in Electrical/Electronic Engineering, Electrical Power Systems, Computer Science, Engineering, or a related field and two (2) years of experience as a Software Engineer or a related occupation preferred.

Required Experience & Technical Skills

7+ years of experience in the operational environment of a Managed Care Organization (MCO).
Extensive Experience with HIPAA compliant transactions and applicable platforms such as Edifecs and BizTalk required**.
Extensive EDI experience, including:
Regression testing
SNIP level validation
Transaction testing and production issue resolution
QNXT experience required (hands-on, operational).
Basic SQL skills required for troubleshooting, data validation, and issue analysis.
Strong knowledge of EDI production environments and workflows.**
Technically savvy with strong proficiency in Microsoft Office (Excel, Word, PowerPoint), internet-based tools, and enterprise systems.**
Experience with HIPAA X12 transactions (e.g., 270/271, 834, 837, 835)**
Experience managing vendor relationships and SLAs**
Familiarity with change management and release coordination**
Experience supporting CMS, Medicaid, Medicare, or MassHealth programs**
On-call or after-hours support expectations **
Experience with audit support, compliance, or regulatory reporting**

Operational & Analytical Skills

Grasps complex systems and identifies relationships across issues, driving problems to closure with urgency.
Strong results-oriented mindset with the ability to work independently.
Ability to track, analyze, and resolve EDI production system issues, including working across technical and business teams.
Handles multiple demands and competing priorities effectively in a fast-paced environment.
Evaluates short- and long-term impacts when making decisions
Uses quantitative data to draw conclusions, identify trends, and support decision-making

Communication & Documentation

Exceptional verbal and written communication skills, including:
Writing routine operational reports and correspondence
Delivering clear presentations/impact analysis to leadership and technical audiences**
Ability to document policies and procedures in a clear, structured format understandable to diverse audiences.
Demonstrated ability to quickly learn and adapt to new technologies and tools.

Professional Attributes

Adaptable and flexible in response to changing priorities.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $130,000 - $135,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 2 days ago (10/26/2026 5:42 PM)

Job ID 8549

# Positions 1

Category First/Mid Level Officials and Managers

Apply About employer

More about this job

Skills

EDI
IBM Power Systems
Computer science
SQL
Troubleshooting
Microsoft Office
Microsoft Excel
Microsoft Word
Microsoft PowerPoint
Change management
CMS
Regulatory compliance
Reporting
Analytical skills
Work independently
Decision making
Communication skills
Documentation
Presentation skills
Adaptability

Report this job