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Claims Data Engineer
Claims Data EngineerNationsBenefits • Plantation, FL, US
Claims Data Engineer

Claims Data Engineer

NationsBenefits • Plantation, FL, US
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  • [job_card.full_time]
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Company Overview :

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.

Position Summary :

We are seeking a seasoned EDI 837 Claims Data Engineer to design, develop, and maintain data pipelines that process healthcare claims in compliance with HIPAA and ANSI X12 standards . This role requires deep expertise in Electronic Data Interchange (EDI) , particularly the 837-transaction set , and will be pivotal in ensuring accurate, timely, and secure claims data exchange across payers, providers, clearinghouses, state agencies, and CMS

Key Responsibilities

EDI Development & Integration

  • Design, build, and maintain pipelines for processing 837 healthcare claim transactions
  • Implement and support EDI workflows across multiple trading partners.
  • Ensure compliance with HIPAA regulations and ANSI X12 standards

Data Engineering

  • Develop ETL processes to transform, validate, and load claims data into enterprise data warehouses.
  • Optimize data flows for scalability, reliability, and performance
  • Collaborate with analysts and stakeholders to ensure claims data accuracy
  • Write and optimize SQL queries, stored procedures, and scripts for validation and reporting.

    • Monitoring & Troubleshooting

  • Monitor EDI transactions for errors, rejections, and compliance issues.
  • Troubleshoot and resolve data mapping, translation, and connectivity problems.
  • Perform root cause analysis and implement corrective actions.

    • Collaboration

  • Work closely with business analysts, QA teams, and IT operations to support claims processing.
  • Partner with healthcare domain experts to align technical solutions with business needs.

    • Required Skills & Qualifications

  • 5+ years of experience in healthcare data engineering or claims integration.
  • Strong expertise with EDI 837 transactions and healthcare claims processing.
  • Proven experience with Medicaid and Medicare data exchanges between state agencies and CMS.
  • Hands-on experience with Databricks, SSIS, and SQL Server.
  • Knowledge of HIPAA compliance, CMS reporting requirements, and interoperability standards.
  • Strong problem-solving skills and ability to work in cross-functional teams.
  • Excellent communication and documentation skills.

    • Preferred Skills

  • Experience with Azure cloud platforms
  • Familiarity with other EDI transactions (835, 270 / 271, 276 / 277).
  • Exposure to data governance frameworks and security best practices
  • Background in data warehousing and healthcare analytics
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