Senior Data Engineer - EDI Claims

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. 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. Role: Senior Data Engineer Plantation, FL (On-site)

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.

EDI 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)

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 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)

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.

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.

Experience with Azure Databricks or other cloud-based data engineering platforms.

Experience with encounter error remediation and state-specific Medicaid edit codes. 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 SQL Server Azure Databricks (Preferred) HIPAA X12 EDI CMS Encounter Processing Data Validation & Reconciliation Healthcare Claims Processing 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.