Senior Data Engineer

About the Role

EDI Data Pipeline Engineering

Claims & Encounter Processing

Data Integration & Validation

Operational Excellence

Cross-Functional Collaboration

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.
• Databricks
• PySpark
• Delta Lake
• SQL Server
• T-SQL
• HIPAA X12 EDI
• Medicaid Encounters
• CMS Encounter Processing
• HIPAA Suite (or equivalent)
• ETL / ELT Development
• Data Validation & Reconciliation
• Healthcare Claims Processing
• 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.

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.
• Azure Databricks (Preferred)
• Azure (Preferred)

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

Why Join Us?

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.