APPLICATIONS PROGRAMMER I

POSITION PURPOSE:

To analyze, design and test program logic, code programs and document system activity and processes. To assist in the daily EDI activities including but not limited to correcting inbound EDI files, creating new files for load to core system and troubleshooting data issues.

NATURE AND SCOPE:

This position reports to the Team Lead, Applications Development.

This position supports and enhances production operations by coordinating and/or performing ongoing eligibility processing, file monitoring, validation activities, and exception management for Medicare-related populations supported by the EDI team.

The role interfaces with internal departments (e.g., Enrollment, Operations, Finance) and external partners to ensure eligibility transactions, attributes/coverage indicators, and reconciliation outputs remain accurate and consistent across systems and reporting.

The incumbent will work with others as needed to obtain or create test data as required to validate system changes/enhancements.

This position functions under the constraints of Health Plan and Office of Personnel Management (OPM) guidelines and policies.

PRIMARY ACCOUNTABILITIES:

Assist with daily EDI activities including but not limited to 834, 837, 277, proprietary and flat files and routing issues to responsible parties for correction.

Ensure data integrity and continuity of file processing through troubleshooting, documentation, and follow-through.

Assist in the development of computer programs including the testing of the finished program before formal testing and production turnover.

Validate updates in source systems and verify successful reprocessing.

Work according to the direction of or project plans laid out by the Team Lead, Applications Development, Manager Application Development or their designee.

Perform other duties as requested.

QUALIFICATIONS:

Associates degree in related field preferred but 2 years of direct experience may be substituted.

Knowledge of CMS Employee Group Health Plan (EGHP) requirements and/or Medicare Advantage Plans.

Experience with health insurance systems, claims processing systems a plus.

Experience supporting eligibility/enrollment operations, data reconciliation, and file-based integrations in a healthcare, insurance, or benefits administration environment.

Knowledge of HIPAA X12 EDI transaction sets, specifically: 834 (Enrollment), 835 (Remittance Advice), 837 (Claims), and 277 (Claim Status Response) preferred.

QNXT experience a plus.

Experience with SQL or other software development tools preferred.