Senior Data Engineer – EDI Claims Processing

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.

• 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.

• Bachelors degree in Computer Science Information Technology Engineering or a related field (or equivalent experience).
• 58 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.

• 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.

• 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)

• 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.

Join a collaborative team where youll help build mission-critical healthcare data platforms that support millions of healthcare transactions. Youll 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.