Senior Data Engineer

Senior Data Engineer

About the Role

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.

Key Responsibilities

• EDI Data Pipeline Engineering

• 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.

• Claims & Encounter Processing

• 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.

• Data Integration & Validation

• 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.

• Operational Excellence

• 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.

• Cross-Functional Collaboration

• 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.

• Required Qualifications

• 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.

• Preferred Qualifications

• 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.

• Technical Skills

• Databricks

• PySpark

• Delta Lake

• SQL Server

• T-SQL

• Azure Databricks (Preferred)

• HIPAA X12 EDI

• Medicaid Encounters

• CMS Encounter Processing

• HIPAA Suite (or equivalent)

• ETL / ELT Development

• Data Validation & Reconciliation

• Healthcare Claims Processing

• Azure (Preferred)

• What You'll Bring

• 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.

• Why Join Us?

• Join a collaborative team where you'll help build mission-critical healthcare data platforms that support millions of healthcare transactions. You'll work with modern data technologies, contribute to large-scale integration initiatives, and play a key role in ensuring secure, compliant, and high-quality healthcare data processing.

• NationsBenefits is an Equal Opportunity Employer.