Data Engineer / EDI and Claims / Hybrid

Job Description
Please apply only if you have experience with claims and EDI X12 submissions and standards, as this accounts for over 70% of the role. Strong healthcare or health insurance experience is also required. This is a hybrid position, requiring two days per week in the NYC office and three days remote.
Our client is unable to provide visa sponsorship currently. Candidates must be legally authorized to work in the United States without the need for current or future sponsorship
Data Engineer / EDI and Claims / Hybrid
Salary up to $135,000 with generous benefits (pension plan)
Full-time Permanent Role, Monday through Friday Business hours
Hybrid (2 days in NYC office and 3 days remote)
Overview
A mission-driven healthcare organization serving New Yorkers for over 30 years is seeking a Data Engineer to join its Analytics & Reporting team. This role will play a pivotal part in improving data quality, ensuring regulatory compliance, and contributing to the integrity of health plan operations across the organization.
If you're passionate about healthcare data, thrive on solving complex data integration issues, and enjoy working in a collaborative environment-this is your chance to make a real impact.
Responsibilities

• Manage and monitor encounter data submissions to state and federal agencies (e.g., NYSDOH, CMS).
• Troubleshoot EDI mapping issues and reporting errors.
• Write complex SQL queries, stored procedures, and SSIS jobs for automated data processing and submissions.
• Collaborate with internal teams and vendors to resolve EDI errors and ensure accurate resubmissions.
• Support the Compliance and Regulatory teams with encounter data inquiries.
• Generate and maintain documentation for EDI processes, workflows, and data quality checks.
• Contribute to MMCOR reporting and develop KPI dashboards to track encounter data performance.
• Participate in QA and testing activities to validate new EDI logic and data handling procedures.

Requirements

• Bachelor's degree in Information Systems, Computer Science, Database Management, or related field.
• 5+ years of SQL Server experience, including stored procedures, SSIS, SSRS, and EDI troubleshooting.
• 3+ years of experience working with healthcare data (claims, enrollment, provider, etc.).
• Solid understanding of EDI X12 standards and file mapping.
• Experience with BI tools like Tableau, Power BI, or BusinessObjects.
• Familiarity with tools such as Visual Studio, .NET, XML, or BizTalk is a plus.