Senior Data Engineer – EDI Claims Processing

NationsBenefits•Plantation, FL

2d•Onsite

About The Position

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction. Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members. We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

Requirements

Bachelor's degree in Computer Science, Information Technology, Engineering, or a related field (or equivalent experience).
5–8+ years of experience as a Data Engineer, Integration Engineer, or Healthcare Data Engineer.
Strong expertise with HIPAA X12 EDI transaction standards, including: 837 (Professional, Institutional, Dental), 277CA, 999, 834, 835
Hands-on experience with Medicaid encounter processing and state Medicaid submissions.
Experience implementing CMS encounter regulations, schema updates, and compliance changes.
Strong experience with Databricks, PySpark, Delta Lake, and SQL Server.
Experience with healthcare claims validation platforms such as HIPAA Suite or similar EDI processing tools.
Strong understanding of: HIPAA regulations, PHI security and data privacy, SNIP validation levels, EDI mapping, loops, segments, and companion guides
Experience integrating with healthcare clearinghouses such as Availity, Change Healthcare, or similar platforms.
Excellent troubleshooting, analytical, and problem-solving skills.
Strong ownership mindset with the ability to work independently on complex technical initiatives.
Excellent communication and collaboration skills across technical and business teams.
Passion for building scalable, reliable, and compliant healthcare data solutions.
Commitment to delivering high-quality data engineering solutions in a fast-paced healthcare environment.

Nice To Haves

Experience with Azure Databricks or other cloud-based data engineering platforms.
Knowledge of healthcare interoperability standards such as FHIR and HL7.
Experience with encounter error remediation and state-specific Medicaid edit codes.
Background supporting Medicaid Managed Care, Medicare Advantage, or Accountable Care Organization (ACO) environments.
Experience building automated reconciliation, validation, and quality assurance frameworks for healthcare EDI transactions.
Familiarity with CI/CD pipelines and DevOps practices for data engineering.

Responsibilities

Design, develop, and optimize enterprise-grade ingestion, parsing, validation, transformation, and delivery pipelines for HIPAA X12 transactions, including: 837 (Professional, Institutional, Dental Claims), 277CA (Claims Acknowledgment), 999 (Implementation Acknowledgment), 834 (Member Eligibility), 835 (Remittance Advice)
Build scalable, high-performance ETL/ELT workflows using Databricks, PySpark, Delta Lake, and SQL Server.
Manage Medicaid encounter submissions, reconciliation, and error remediation with state Medicaid agencies.
Support CMS encounter processing by implementing regulatory updates, schema changes, and compliance requirements.
Collaborate with internal teams to ensure accurate and timely claims submissions.
Develop automated validation frameworks to ensure HIPAA compliance, SNIP validation, and business rule enforcement.
Maintain secure and reliable integrations with healthcare clearinghouses and trading partners.
Analyze and troubleshoot complex EDI processing issues across multiple systems.
Build monitoring, alerting, logging, and SLA reporting for production EDI workflows.
Continuously improve pipeline performance, scalability, and reliability.
Maintain technical documentation, mapping specifications, companion guide implementations, and data dictionaries.
Partner with Claims Operations, Compliance, Product, IT Security, and external healthcare partners to support enterprise data integration initiatives.
Participate in architecture discussions and recommend best practices for healthcare data engineering.