Sr. EDI Engineer & Data Architect

Sr. EDI Engineer & Data Architect

Role Summary

Everything we do starts with claims data arriving correctly. This role owns that front door and everything immediately behind it.

It is two jobs that belong together. The intake half is about movement and fidelity: onboarding trading partners, interpreting companion guides and file specs, and parsing and validating incoming data — X12 EDI transactions, flat files, and other structured or unstructured data files — so that nothing is silently dropped, duplicated, or mistranslated on the way in. The data architecture half is about what happens next: shaping raw transactions and files into member, provider, claim, and payment models that the rest of the business can query with confidence.

You will live in SQL and you will be fluent in it, not just functional. You will work in the Microsoft Fabric and Azure data stack. We expect you to use AI tools as part of how you work, whether that is accelerating a new partner mapping, pulling structure out of an unstructured attachment, or flagging anomalies in a file that looks fine until it is not. We are a small company, so this seat sets the data standard rather than inheriting one. This is a remote position; candidates in or around Memphis, TN are preferred.

Core Responsibilities

• Own the intake, parsing, translation, and validation of incoming data files, including X12 healthcare transactions (837 institutional, professional, and dental, 835 remittance, 834 enrollment, 270/271 eligibility, and 276/277 claim status, along with 999 and TA1 acknowledgment handling), as well as flat files (fixed-width, delimited, CSV) and other unstructured or semi-structured data sources (PDFs, scanned documents, attachments) received from trading partners and vendors.
• Onboard and maintain data partners and clearinghouses end to end: companion guide interpretation, mapping, connectivity, test and certification cycles, and production cutover.
• Design and maintain the claims data architecture from raw landing through curated, query-ready models, with clear layering, naming, and ownership.
• Model claims, member, provider, and payment data, including standard code sets such as ICD-10, CPT and HCPCS, NPI, revenue codes, and adjustment and remark codes.
• Write and tune complex, high-performance SQL against large claims data sets, including query optimization, indexing, and execution plan analysis when things run slow.
• Build and operate data pipelines in Microsoft Fabric and the Azure data stack: ingestion, transformation, orchestration, scheduling, alerting, and monitoring.
• Establish data quality and reconciliation controls: file-level and claim-level balancing, duplicate detection, rejection handling, and clean reprocessing paths when something needs to be run again.
• Handle inputs that are not neatly formatted, including flat files, spreadsheets, and document-based submissions, and bring them into the same governed model.
• Apply AI tools where they genuinely shorten the work: drafting and testing new partner mappings, extracting structure from unstructured files and attachments, detecting anomalies, and accelerating development and documentation.
• Spot opportunities in the data while organizing chaos and cutting through noise, and surface what the data can support that no one has asked for yet.
• Define data contracts, lineage, retention, and documentation so the pipeline is understandable by someone other than its author.
• Protect PHI throughout: access controls, minimum necessary, encryption in transit and at rest, and auditability.
• Set data engineering standards and raise the technical bar for how data work gets done here.

Experience

• 8+ years in data engineering, EDI engineering, or data architecture, with substantial time spent on healthcare claims data.
• Deep hands-on experience with HIPAA X12 5010 transactions, particularly 837 and 835, including acknowledgment and error handling.
• Experience with an EDI translation or integration platform, or with maintaining custom parsers and mapping logic.
• Hands-on experience onboarding data partners and working the clearinghouse side of the pipe.
• Expert SQL skills, including complex joins, window functions, stored procedures, and performance tuning on large tables.
• Strong data modeling background, including dimensional modeling and modern lakehouse or medallion layering.
• Experience with Microsoft Fabric and the Azure data stack, such as Data Factory, Synapse, Data Lake, and Delta or Parquet formats.
• Working knowledge of healthcare code sets and claims reference data.
• Practical, day-to-day use of AI tools in engineering work, with judgment about where they help and where they should not be trusted.
• Proficiency in Python or a comparable language for data work.
• Knowledge of healthcare and insurance data is strongly preferred.

Required Competencies

• Precision. In this domain a quiet mapping error becomes a revenue problem months later.
• Ability to hold both views at once: the transaction-level detail and the architecture it rolls up into.
• Solid engineering habits: version control, testing, code review, reproducibility, and documentation.
• Comfort working with imperfect, inconsistent, real-world data from many different senders.
• Clear communication of data issues, tradeoffs, and root cause for both technical and business audiences.
• Self-starter with a track record of achievement who will roll up sleeves to tackle hard projects.

Education

• B.S./B.A. required in Computer Science, Information Systems, Statistics, a related technical field, or equivalent experience.

License/Certification

• Microsoft Fabric or Azure data certification (e.g., DP-600 or DP-203) preferred.
• Healthcare data or HIPAA-related certification a plus.

Preferred

• Experience with subrogation, third-party liability, coordination of benefits, or payment integrity data.
• Experience with member and provider matching, entity resolution, or master data management.
• Experience building semantic models and supporting business intelligence consumers.
• Experience in a SOC 2, HITRUST, or similarly audited environment.
• Experience with NCPDP pharmacy transactions.
• Located in or around Memphis, TN.

Who is Intellivo?

As an industry market leader in subrogation, Intellivo empowers health plans and insurers to maximize financial outcomes by identifying and pursuing more reimbursement opportunities from alternative third-party liability (TPL) payers. Through innovative technology, Intellivo accelerates the identification of reimbursement opportunities while eliminating burdensome outreach to plan members. With a 26-year history of excellence, Intellivo proudly represents more than 200 of the country’s largest health plans.

We are Intellivators – forward-thinking pioneers building the technologies that Fortune 500 employers, health plans, TPAs, providers, and billing organizations rely on to ensure responsible claim payments. Fueled by our experience and innovative startup mentality, we are growing fast.

Benefits That Support You Inside and Outside of Work

• Comprehensive medical, dental, and vision insurance
• 401(k) retirement savings plan with employer match
• Paid time off and paid holidays
• Company-paid life insurance and short-term and long-term disability coverage
• Employee Assistance Program with counseling, financial coaching, legal resources, career coaching, and wellness support
• Health Savings Account with company contributions for eligible employees
• Wellness, healthcare advocacy, and pet benefits
• A high-performing, collaborative culture built on ownership, accountability, continuous improvement, and meaningful impact

Equal Opportunity Employer

Intellivo is an Equal Opportunity Employer and does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status. Employment decisions are based on qualifications, merit, and business need.