Senior Data Engineer

NationsBenefits; Plantation (FL); On-site; USD 110,000 - 170,000; Full time

Job summary

NationsBenefits in Florida is seeking a Senior Data Engineer – EDI Claims Processing to design, develop, and support enterprise healthcare data integration solutions. You will build scalable data pipelines that handle HIPAA X12 EDI transactions, Medicaid encounters, CMS submissions, and claims data.

The role requires deep expertise in Databricks, PySpark, Delta Lake, and Microsoft SQL Server, plus the ability to partner with Claims Ops, Compliance, IT Security, and business teams to deliver

Qualifications

• Bachelor's degree or equivalent in a relevant field.
• 5–8+ years of experience as a Data Engineer, Integration Engineer, or Healthcare Data Engineer.
• Strong experience with Databricks, PySpark, Delta Lake, and Microsoft SQL Server.

Responsibilities

• Design, develop, and maintain enterprise-grade ETL/ELT pipelines for healthcare claims and encounter processing using Databricks (PySpark, Delta Lake) and Microsoft SQL Server.
• Develop and support HIPAA X12 EDI processing for 837 (Professional, Institutional, and Dental), 277CA, 999, 834, and 835 transactions.
• Build automated ingestion, parsing, validation, transformation, and reconciliation processes for healthcare EDI data.
• Manage Medicaid encounter submissions, reconciliation activities, and error remediation with state Medicaid agencies.
• Implement CMS encounter processing updates, regulatory changes, and compliance requirements.
• Develop automated validation frameworks to ensure HIPAA compliance, SNIP validation, and business rule enforcement.
• Maintain secure integrations with healthcare clearinghouses and external trading partners, including Availity, Change Healthcare, or equivalent platforms.
• Monitor, troubleshoot, and optimize production EDI pipelines to ensure reliability, scalability, and SLA compliance.
• Perform root cause analysis and resolve complex data integration and claims processing issues.
• Create and maintain technical documentation, EDI mapping specifications, companion guide implementations, and data dictionaries.
• Partner with Claims Operations, Compliance, IT Security, Product, and Business teams to deliver enterprise healthcare data solutions.
• Participate in architecture discussions and recommend best practices for healthcare data engineering and integration.

Education

Bachelor's degree in Computer Science, Information Technology, Engineering, or a related field

Tools

Databricks

PySpark

Delta Lake

Microsoft SQL Server

T-SQL

HIPAA X12 EDI

Medicaid Encounters

CMS Encounter Processing

HIPAA Suite

SNIP Validation

EDI Mapping

HL7 & FHIR

Job description

Employment Type: Full-Time

Position Summary

The Technology & Data Team is seeking an experienced Senior Data Engineer – EDI Claims Processing to design, develop, and support enterprise healthcare data integration solutions. This role is responsible for building and optimizing scalable data pipelines that process HIPAA X12 EDI transactions, Medicaid encounters, CMS submissions, and healthcare claims data.

The ideal candidate will possess deep expertise in healthcare EDI standards, Databricks, SQL Server, and healthcare claims processing. This individual will collaborate with cross-functional teams to deliver secure, scalable, and compliant data solutions that support business operations and regulatory requirements.

Key Responsibilities

• Design, develop, and maintain enterprise-grade ETL/ELT pipelines for healthcare claims and encounter processing using Databricks (PySpark, Delta Lake) and Microsoft SQL Server.
• Develop and support HIPAA X12 EDI processing for 837 (Professional, Institutional, Dental), 277CA, 999, 834, and 835 transactions.
• Build automated ingestion, parsing, validation, transformation, and reconciliation processes for healthcare EDI data.
• Manage Medicaid encounter submissions, reconciliation activities, and error remediation with state Medicaid agencies.
• Implement CMS encounter processing updates, regulatory changes, and compliance requirements.
• Develop automated validation frameworks to ensure HIPAA compliance, SNIP validation, and business rule enforcement.
• Maintain secure integrations with healthcare clearinghouses and external trading partners, including Availity, Change Healthcare, or equivalent platforms.
• Monitor, troubleshoot, and optimize production EDI pipelines to ensure reliability, scalability, and SLA compliance.
• Perform root cause analysis and resolve complex data integration and claims processing issues.
• Create and maintain technical documentation, EDI mapping specifications, companion guide implementations, and data dictionaries.
• Partner with Claims Operations, Compliance, IT Security, Product, and Business teams to deliver enterprise healthcare data solutions.
• Participate in architecture discussions and recommend best practices for healthcare data engineering and integration.

Required Qualifications

• Bachelor's degree in Computer Science, Information Technology, Engineering, or a related field, or equivalent work experience.
• 5–8+ years of experience as a Data Engineer, Integration Engineer, or Healthcare Data Engineer.
• Strong experience developing healthcare data integration solutions using Databricks, PySpark, Delta Lake, and Microsoft SQL Server.
• Deep knowledge of HIPAA X12 EDI transaction standards, including:
• 837 Professional, Institutional, and Dental Claims
• 277CA Claim Acknowledgments
• 999 Implementation Acknowledgments
• Experience supporting Medicaid encounter submissions and working with state Medicaid agencies.
• Experience implementing CMS encounter processing requirements and regulatory updates.
• Hands‑on experience with healthcare claims processing and validation platforms such as HIPAA Suite or similar EDI tools.
• Strong understanding of HIPAA regulations, PHI security, SNIP validation levels, and healthcare compliance requirements.
• Experience with EDI mapping, loops, segments, companion guides, and transaction validation.
• Experience integrating with healthcare clearinghouses such as Availity, Change Healthcare, or similar organizations.
• Strong SQL development skills, including query optimization, stored procedures, and database performance tuning.
• Excellent analytical, troubleshooting, and problem-solving skills.
• Strong communication and collaboration skills with both technical and business stakeholders.

Preferred Qualifications

• Experience with Azure Databricks or other cloud-based data engineering platforms.
• Knowledge of healthcare interoperability standards, including HL7 and FHIR.
• Experience with encounter error remediation and state-specific Medicaid edit codes.
• Experience supporting Medicaid Managed Care, Medicare Advantage, or Accountable Care Organization (ACO) environments.
• Experience building automated data quality, reconciliation, and validation frameworks.
• Familiarity with CI/CD pipelines, Azure DevOps, or other DevOps practices for data engineering.

Technical Skills

• Databricks
• PySpark
• Microsoft SQL Server
• T-SQL
• ETL/ELT Development
• HIPAA X12 EDI
• Medicaid Encounters
• CMS Encounter Processing
• HIPAA Suite (or equivalent)
• SNIP Validation
• EDI Mapping
• HL7 & FHIR (Preferred)

Why Join Us?

Join our Technology & Data Team and play a critical role in building scalable healthcare data solutions that support enterprise claims processing, regulatory compliance, and operational excellence. You'll work with modern data engineering technologies, collaborate with experienced professionals, and contribute to innovative healthcare initiatives that make a meaningful impact.