Senior Data Engineer – EDI Claims Processing

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

This is Syed Yousuf Uddin, I am a Senior Recruiter at NationsBenefits. 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 DevOps practices for data engineering.

Technical Skills:

• Databricks
• PySpark
• 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.