Location: Plantation, FL (On-site)
Senior Data EngineerAbout 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 ResponsibilitiesEDI Data Pipeline Engineering- 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.
- 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.
- 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.
- 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)
- 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.
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.
Skills Required
- 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
- Expertise with HIPAA X12 EDI transaction standards, including 837, 277CA, 999, 834, and 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
- Understanding of HIPAA regulations, PHI security, 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
- 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 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
NationsBenefits Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about NationsBenefits and has not been reviewed or approved by NationsBenefits.
-
Fair & Transparent Compensation — Pay is frequently characterized as decent or good for certain entry-level and frontline roles, with timely pay also highlighted. Compensation is sometimes positioned as competitive relative to the work performed in those positions.
-
Leave & Time Off Breadth — Unlimited PTO is described as available for some salaried roles, which can increase perceived flexibility. Paid holidays and paid time off are presented as part of the standard package for eligible employees.
-
Wellbeing & Lifestyle Benefits — A fitness stipend and occasional company-sponsored outings or training-related perks are included among the extra benefits. These additions can modestly strengthen the overall rewards experience beyond core insurance.
NationsBenefits Insights
What We Do
NationsBenefits® is a leading supplemental benefits company providing managed care organizations with innovative healthcare solutions helping to promote independence, health, and well-being for more than 20 million members across the U.S. When the company was founded in 2015 by Glenn Parker, M.D., we set out to disrupt the healthcare industry. In 2020, we rebranded to NationsBenefits to expand the company’s core offering and broaden the scope of our clinically focused services. Today, we surpass traditional benefit management programs by helping our health plan partners drive growth, improve outcomes, reduce costs, and delight members. Our best-in-class service model engages members in meaningful and measurable ways with technology-based solutions tailored to the unique needs of each population.
.png)
