Sam Kumar
San Francisco,CA
Summary
Experienced Sr EDI Lead with 10+ years of end-to-end experience in Electronic Data Interchange (EDI) development, mapping, and support for payers, providers, and clearinghouses. Expert in HIPAA 5010 transaction sets (834, 837, 835, 270/271, 276/277), trading-partner onboarding, and B2B integration using Sterling B2B Integrator, Gentran, BizTalk, and Seeburger.
Skilled in collaborating with cross-functional stakeholders – business, QA, infrastructure, and compliance – to streamline claim, payment, and enrollment workflows. Recognized for ensuring data integrity, regulatory compliance, and operational excellence in enterprise healthcare ecosystems.
Overview
11
11
years of professional experience
1
1
Certification
Work History
EDI Lead
Blue Cross Blue Shield
03.2019 - Current
- Manage an 8 member onshore and offshore EDI team supporting HIPPA transactions for 3M plus members and 60 partners.
- Conduct capacity planning, daily stand-ups and performance reviews aligned with SLA's and KPI's.
- Partner with business and QA teams to design, test and deploy EDI maps and communication protocols.
- Own full lifecycle of 837, 835, 834, 270, 271 transactions in IBM sterling B2B integrator.
- Managed all aspects of daily EDI operations, including new partner onboarding, issue resolution, production monitoring, and support of mainframe or cloud-based EDI systems.
- Created and maintained comprehensive documentation, including data specifications, implementation guides, process flow charts, and standard operating procedures.
- Standardized ISA/GS identifiers and partner templates to cut onboarding time by 75%.
- Supervise HIPAA compliance, PHI security, and SOC 2 evidence collection for audits.
- Lead monthly reviews with Claims, Finance, and Compliance teams to resolve rejections and map defects.
- Performed source to destination data mapping to migrate data from legacy to new system.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Managed time efficiently in order to complete all tasks within deadlines.
Senior EDI Analyst
UnitedHealth Group
02.2015 - 02.2019
- Designed and tested HIPAA transactions 270/271, 276/277, 834, 837, 835 using Gentran Server and Sterling Integrator.
- Analyzed EDI transactions to ensure compliance with industry standards and regulations.
- Maintained accurate records of all EDI mappings, schedules, profiles, and partner information for quick reference when needed.
- Developed and maintained documentation for EDI processes and protocols.
- Collaborated with cross-functional teams to optimize data exchange workflows.
- Implemented system enhancements that improved processing efficiency and accuracy.
- Led training sessions for staff on EDI systems and best practices.
- Troubleshot EDI issues, providing timely resolutions to minimize disruptions.
- Evaluated vendor performance related to EDI services, driving improvements in partnerships.
- Managed project timelines for EDI implementations, ensuring on-time delivery of solutions.
- Contributed to the development of training materials for employees transitioning into roles that required familiarity with EDI concepts or responsibilities.
- Ensured compliance with industry standards, researching updates to the ANSI X12 format as needed.
- Developed comprehensive testing plans for validating incoming and outgoing EDI transactions, ensuring accuracy and reliability.
- Streamlined EDI processes for increased productivity with detailed documentation and standard operating procedures.
- Improved EDI system efficiency by analyzing and troubleshooting discrepancies and data issues.
- Mitigated risks associated with electronic data exchange by establishing secure protocols that protected sensitive information from unauthorized access.
Education
Bachelor of Science - Computer Science
JNTU
India09-2011
Skills
EDI Platforms : Cleo Integration Cloud (CIC), IBM Sterling B2B Integrator, Gentran Server, Seeburger, BizTalk Server 2016
Standards & Protocols : X12, EDIFACT, HL7, HIPAA 5010, AS2, SFTP, FTP
Integration & Dev : Mapping/specs, routing rules, functional acks (999, 277CA), API extracts, UAT planning, CI/CD handoffs
Governance : HIPAA 5010/PHI, audit readiness, runbooks/SOPs, privacy training, ticketing (Zendesk, ServiceNow)
Databases & Reporting : SQL Server, Oracle DB, Power BI, Tableau
Project Tools : JIRA, Confluence, ServiceNow, MS Project, Visio
OS / Platforms : Windows Server, Linux, Azure Cloud
Accomplishments
- Improved EDI transaction uptime from 96% to 99.9% through automation and proactive monitoring.
- Reduced partner onboarding time by 50% through reusable templates and test playbooks.
- Led remediation of error-prone837 claim feeds, cutting manual reconciliation time by 60%.
- Implemented data streaming architecture for near real-time claim status updates, reducing SLA from 24h to less than 2h.
- Established KPI dashboard in Power BI for leadership visibility, resulting in 15% faster project decision cycles.
Certification
AZ-900: Microsoft Azure Fundamentals
DP-300: Azure Database Administrator Associate
Databricks Lakehouse Fundamental
Professional Scrum Master I (PSM I)
Timeline
EDI Lead
Blue Cross Blue Shield
03.2019 - Current
Senior EDI Analyst
UnitedHealth Group
02.2015 - 02.2019
Bachelor of Science - Computer Science
JNTU