Senior Data Engineer – EDI Claims Processing

This is Syed Yousuf Uddin, I am a Senior Recruiter at Nations Benefits.
We are seeking an experienced Senior Data Engineer – EDI Claims Processing to join our growing Data Engineering team.

Location:
Plantation, FL (On-site)

Role:
Full-time

• 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:

• Design, develop, and optimize enterprise-grade ingestion, parsing, validation, transformation, and delivery pipelines for HIPAA X12 transactions, including:
• 277CA (Claims Acknowledgment)
• 999 (Implementation Acknowledgment)
• 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:
• 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
• 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 Dev Ops practices for data engineering.

Technical

Skills:

• Databricks
• Py Spark
• SQL Server
• T-SQL
• HIPAA X12 EDI
• Medicaid Encounters
• CMS Encounter Processing
• HIPAA Suite (or equivalent)
• ETL / ELT Development

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.