Senior Data Engineer – EDI Claims Processing
NationsBenefits, LLC•Plantation, FL
•Onsite
About The Position
We are seeking an experienced Senior Data Engineer – EDI Claims Processing to join our growing Data Engineering team. This role is responsible for designing, developing, and maintaining enterprise-scale healthcare data integration solutions focused on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance. The ideal candidate has extensive experience building high-volume data pipelines using Databricks and SQL Server, a deep understanding of HIPAA X12 transaction standards, and hands-on experience supporting healthcare claims processing, clearinghouse integrations, and regulatory compliance. This is an excellent opportunity for a healthcare data engineering professional who enjoys solving complex integration challenges while delivering reliable, scalable, and compliant data solutions.
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.
Benefits
- career advancement opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Senior
