Data Engineer, Healthcare Claims
Job Summary
To support the development of claims data infrastructure, the full-time remote Data Engineer, Healthcare Claims will manage the transformation of health plan medical claims data into standardized datasets, ensuring data quality and facilitating medical economics analysis.
Key Responsibilities
- Build reliable processes for ingesting and validating medical and pharmacy claims and related enrollment files
- Design a standardized claims data model and map partner-specific file structures into Protera's common claims structure
- Translate actuarial and medical economics requirements into scalable datasets and reporting logic
Required Qualifications
- Bachelor's degree in Computer Science, Health Informatics, Information Systems, or a related technical discipline
- 7+ years of experience in healthcare claims data engineering supporting medical economics and actuarial departments
- Strong understanding of claims adjudication, including adjusted, replacement, reversed, denied, and voided claims
- Experience with BigQuery, Google Cloud Platform, Cloud Storage, PostgreSQL, and Terraform
- Advanced SQL skills and experience designing analytical data models for large healthcare datasets
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