Lead Data Engineer, Healthcare Revenue & Risk

CVS Health Corporation; Connecticut; Hybrid; USD 83,000 - 183,000; Full time

Job summary

CVS Health in Connecticut is seeking an experienced Data Engineer to own the Medicare revenue data foundation. You will work with claims, encounters, eligibility, clinical sources, and CMS files, building production-grade lakehouse pipelines with Databricks, Spark, Python, and SQL to keep data timely, complete, and auditable for Finance.

You will establish data quality, lineage, and snapshot processes, define SLAs, monitor source-system changes, and mentor engineers in a regulated, financially

Qualifications

• 8+ years in data engineering.
• 4+ years of expert level experience in healthcare data: claims, encounters, eligibility, provider, and clinical/chart sources.
• 4+ years of hands-on production experience with Databricks / Spark (PySpark), Python, and SQL/ Lakehouse / ELT patterns, orchestration (e.g., Airflow or equivalent).
• 4+ years of experience supporting risk-adjustment, actuarial, or finance workloads (reconciliation, point-in-time history, auditability).
• Strong understanding of PHI, HIPAA, and controls appropriate to revenue and CMS-submission data.

Responsibilities

• Design, build, and operate the data pipelines and analytic tables that feed the Medicare revenue projection model (member-month grain, HCC/diagnosis history, engagement/visit flags, CMS files, program attributes).
• Ingest, normalize, and reconcile: claims/encounters (837 and internal), eligibility/enrollment, EMR/chart extracts, vendor/program files, and CMS artifacts (MMR, MOR, MAO-004, and related).
• Implement HCC / ICD-10 mapping, model-year (e.g., V24/V28) versioning, and diagnosis-year vs. payment-year constructs so modelers do not have to reverse-engineer source systems.
• Own data quality, reconciliation, lineage, and snapshot/freeze processes required for accruals, AtoE, and audit.
• Partner with enterprise data/IT on Databricks (or equivalent) lakehouse standards: Spark/PySpark, orchestration, CI/CD, access control, and cost/performance.
• Provide trusted, documented datasets to Modeling, Finance, Actuarial, and (as needed) Revenue Integrity.
• Define SLAs for freshness and completeness; monitor drift and source-system changes that would invalidate forecasts.
• Lead and mentor data engineers; set engineering practices for a regulated, financially sensitive environment.
• Support modular outputs (revenue, membership/mix, other items) so the engine can evolve without rewriting the warehouse.

Skills

Data engineering

Healthcare data

Databricks

PySpark

Python

SQL

Airflow

PHI HIPAA

Education

Bachelor's in CS/engineering

Tools

Databricks

Spark

Airflow

Job description

CVS Health in Connecticut is seeking an experienced Data Engineer to own the Medicare revenue data foundation. You will work with claims, encounters, eligibility, clinical sources, and CMS files, building production-grade lakehouse pipelines with Databricks, Spark, Python, and SQL to keep data timely, complete, and auditable for Finance.

You will establish data quality, lineage, and snapshot processes, define SLAs, monitor source-system changes, and mentor engineers in a regulated, financially