About
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 .
Languages
- English
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