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:
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837 (Professional, Institutional, Dental Claims)
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277CA (Claims Acknowledgment)
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999 (Implementation Acknowledgment)
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834 (Member Eligibility)
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835 (Remittance Advice)
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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.
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Support CMS encounter processing by implementing regulatory updates, schema changes, and compliance requirements.
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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.
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Maintain secure and reliable integrations with healthcare clearinghouses and trading partners.
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Analyze and troubleshoot complex EDI processing issues across multiple systems.
- Build monitoring, alerting, logging, and SLA reporting for production EDI workflows.
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Continuously improve pipeline performance, scalability, and reliability.
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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.
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Participate in architecture discussions and recommend best practices for healthcare data engineering.
- Bachelor's degree in Computer Science, Information Technology, Engineering, or a related field (or equivalent experience).
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5–8+ years of experience as a Data Engineer, Integration Engineer, or Healthcare Data Engineer.
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Strong expertise with HIPAA X12 EDI transaction standards, including:
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837 (Professional, Institutional, Dental)
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277CA
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999
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834
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835
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Hands-on experience with Medicaid encounter processing and state Medicaid submissions.
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Experience implementing CMS encounter regulations, schema updates, and compliance changes.
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Strong experience with Databricks, PySpark, Delta Lake, and SQL Server.
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Experience with healthcare claims validation platforms such as HIPAA Suite or similar EDI processing tools.
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Strong understanding of:
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HIPAA regulations
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PHI security and data privacy
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SNIP validation levels
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EDI mapping, loops, segments, and companion guides
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Experience integrating with healthcare clearinghouses such as Availity, Change Healthcare, or similar platforms.
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Excellent troubleshooting, analytical, and problem-solving skills.
- Experience with Azure Databricks or other cloud-based data engineering platforms.
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Knowledge of healthcare interoperability standards such as FHIR and HL7.
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Experience with encounter error remediation and state-specific Medicaid edit codes.
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Background supporting Medicaid Managed Care, Medicare Advantage, or Accountable Care Organization (ACO) environments.
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Experience building automated reconciliation, validation, and quality assurance frameworks for healthcare EDI transactions.
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Familiarity with CI/CD pipelines and DevOps practices for data engineering.
- Databricks
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PySpark
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Delta Lake
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SQL Server
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T-SQL
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Azure Databricks (Preferred)
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HIPAA X12 EDI
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Medicaid Encounters
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CMS Encounter Processing
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HIPAA Suite (or equivalent)
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ETL / ELT Development
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Data Validation & Reconciliation
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Healthcare Claims Processing
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Azure (Preferred)
- Strong ownership mindset with the ability to work independently on complex technical initiatives.
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Excellent communication and collaboration skills across technical and business teams.
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Passion for building scalable, reliable, and compliant healthcare data solutions.
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Commitment to delivering high-quality data engineering solutions in a fast-paced healthcare environment.
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.
