Senior Data Engineer - EDI Claims (HIPAA X12, On-site)

NationsBenefits India; Plantation (FL); On-site; USD 130,000 - 170,000; Full time

Job summary

NationsBenefits seeks an experienced Senior Data Engineer – EDI Claims Processing to join its Data Engineering team in Plantation, FL on-site. You will design and maintain enterprise-scale healthcare data integration solutions centered on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance.

The role requires hands-on experience with Databricks, PySpark, Delta Lake, and SQL Server to build high-volume pipelines and support claims processing and regulatory updates.

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.

Responsibilities

• Design, develop, and optimize ingestion, parsing, validation, transformation, and delivery pipelines for HIPAA X12 transactions.
• 277CA (Claims Acknowledgment)
• 999 (Implementation Acknowledgment)
• Build scalable 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.

Skills

HIPAA X12 EDI

Medicaid Encounters

CMS Encounter Processing

Databricks

PySpark

Delta Lake

SQL Server

ETL Development

HIPAA Suite

Clearinghouses Integrations

Data Privacy

Education

Bachelor's degree in CS/IT/Engineering or related field

Tools

Databricks

PySpark

Delta Lake

SQL Server

Job description

NationsBenefits seeks an experienced Senior Data Engineer – EDI Claims Processing to join its Data Engineering team in Plantation, FL on-site. You will design and maintain enterprise-scale healthcare data integration solutions centered on HIPAA X12 EDI transactions, Medicaid encounters, and CMS compliance.

The role requires hands-on experience with Databricks, PySpark, Delta Lake, and SQL Server to build high-volume pipelines and support claims processing and regulatory updates.