Senior Data Engineer – EDI Claims Processing

NationsBenefits; Plantation (FL); On-site; USD 120,000 - 180,000; Full time

Job summary

NationsBenefits is seeking an experienced Senior Data Engineer – EDI Claims Processing to design, develop, and maintain enterprise-scale data integrations for HIPAA X12 transactions and CMS compliance. You will build high-volume data pipelines using Databricks, PySpark, Delta Lake, and SQL Server, with focus on Medicaid encounters and pharmaceutical/claims processing.

Ideal candidates will have deep knowledge of HIPAA X12 standards, approvals for CMS regulations, and proven ability to deliver

Qualifications

• Bachelor's degree in Computer Science, IT, Engineering, or related field or equivalent experience.
• 5–8+ years of Data Engineer/Integration Engineer/Healthcare Data Engineer experience.
• Strong expertise with HIPAA X12 EDI standards (837, 277CA, 999, 834, 835).
• Hands-on Medicaid encounter processing and state submissions.
• Experience with CMS encounter regulations, schema updates, and compliance changes.
• Proficiency with Databricks, PySpark, Delta Lake, and SQL Server.
• Experience with HIPAA Suite or similar EDI processing tools.
• Understanding of HIPAA, PHI security, SNIP validation, and EDI mapping.

Responsibilities

• Design, develop, and optimize ingestion, parsing, validation, transformation, and delivery pipelines for HIPAA X12 transactions (837, 277CA, 999, 834, 835).
• Build scalable ETL/ELT workflows using Databricks, PySpark, Delta Lake, and SQL Server.
• Manage Medicaid encounters submissions, reconciliation, and error remediation with state agencies.
• Support CMS encounter processing by implementing regulatory updates and schema changes.
• Collaborate with teams to ensure accurate and timely claims submissions.
• Develop automated validation frameworks to ensure HIPAA compliance and SNIP validation.
• Maintain secure integrations with healthcare clearinghouses and trading partners.
• Troubleshoot complex EDI processing issues across systems.
• Build monitoring, logging, alerts, and SLA reporting for production EDI workflows.
• Improve pipeline performance, scalability, and reliability.
• Maintain data mappings, companion guides, and data dictionaries.

Skills

Databricks

PySpark

Delta Lake

SQL Server

T-SQL

HIPAA X12 EDI

Medicaid Encounters

CMS Encounter Processing

HIPAA Suite

ETL/ELT Development

Data Validation

Reconciliation

Healthcare Claims Processing

Azure Databricks

Azure

Education

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

Tools

Databricks

PySpark

Delta Lake

SQL Server

T-SQL

Azure Databricks

Job description

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

Location: Plantation, FL (On-site)

Senior Data Engineer

About The Role

We are seeking an experienced Senior Data Engineer – EDI Claims Processing to join our growing Data Engineering team. 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:
  • 837 (Professional, Institutional, Dental Claims)
  • 277CA (Claims Acknowledgment)
  • 999 (Implementation Acknowledgment)
  • 834 (Member Eligibility)
  • 835 (Remittance Advice)
• Build scalable, high-performance ETL/ELT workflows using Databricks, PySpark, Delta Lake, and SQL Server.
• 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.
• 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.
• 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.
• 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:
  • 837 (Professional, Institutional, Dental)
  • 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
  • SNIP validation levels
  • 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
• Delta Lake
• SQL Server
• T-SQL
• Azure Databricks (Preferred)
• HIPAA X12 EDI
• Medicaid Encounters
• CMS Encounter Processing
• HIPAA Suite (or equivalent)
• ETL / ELT Development
• Data Validation & Reconciliation
• Healthcare Claims Processing
• Azure (Preferred)

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.

Why Join Us?

Join a collaborative team where you'll help build mission-critical healthcare data platforms that support millions of healthcare transactions. You'll work with modern data technologies, contribute to large-scale integration initiatives, and play a key role in ensuring secure, compliant, and high-quality healthcare data processing.

NationsBenefits is an Equal Opportunity Employer.