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.

Data Engineer / EDI and Claims / Hybrid
Salary up to $135,000 + Generous Benefits (including a pension plan!)
Full-time, Permanent Role | Monday–Friday Business Hours
Hybrid (2 days in NYC office, 3 days remote)

About the Organization
For over 30 years, this health plan has been dedicated to providing high-quality healthcare services and building strong relationships with its members and providers. Serving residents across the Bronx, Brooklyn, Manhattan, Queens, and Staten Island, they offer a comprehensive range of health coverage options to help New Yorkers live their healthiest lives.

Position Overview
The Data Engineer will play a key role in the Analytics & Reporting Department, managing Encounter Data submissions to regulatory agencies such as NYSDOH and CMS. Responsibilities include troubleshooting EDI mapping issues, analyzing encounter data quality reports, ensuring compliance with EDI standards, and developing SQL queries, stored procedures, and SSIS jobs for data submission. This role also involves collaboration with cross-functional teams to resolve EDI issues and optimize data accuracy.

Key Responsibilities

• Monitor and submit Encounter Data files to NYSDOH OSDS and CMS.
• Collaborate with vendors and end users to correct EDI error transactions and resubmit data as needed.
• Automate manual processes for Encounter Data submissions.
• Support Compliance & Regulatory teams with Encounter Data inquiries.
• Assist in MMCOR reporting and regulatory data needs.
• Develop KPI reports related to Encounter Data submissions.
• Write and maintain SQL stored procedures and flow diagrams to document Encounter Data processes.
• Troubleshoot EDI errors and track all necessary resubmissions.

Qualifications & Skills

• Bachelor’s degree in information systems, Computer Science, Database Management, or related field.
• Minimum 5 years of programming experience in SQL Server database object development including but not limited to stored procedures, functions, views, SSIS and SSRS, X12 EDI mapping and development, and troubleshooting EDI errors.
• Minimum 3 years’ experience in complex healthcare data like Claims and Enrollment.
• Working knowledge of EDI X12 standards
• Previous experience in BI reporting tools, such as BusinessObjects, Tableau, or Power BI
• Knowledge of Visual Studio, .NET Development, XML, BizTalk.

If you’re an experienced SQL and EDI professional with a strong healthcare data background, this is an excellent opportunity to work on impactful data projects in a stable and mission-driven organization.

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