Note: The job is a remote job and is open to candidates in USA. Protera Health is a digital health company reimagining musculoskeletal care through technology, evidence-based clinical pathways, and personalized human care. The Data Engineer, Healthcare Claims will build claims data infrastructure, normalize health plan data, develop production-ready pipelines and models, and support medical economics, actuarial analysis, reporting, and value-based care programs.
Responsibilities
- Build reliable processes for ingesting and validating historical and incremental medical and pharmacy claims along with related enrollment files
- Process full data refreshes, recurring files, and retroactive claims activity accounting for adjusted, reversed and replacement claims
- Reconcile incoming claims against previously processed data and investigate discrepancies
- Implement automated checks for completeness, duplicates, schema changes, unexpected volumes, financial reconciliation, and data freshness
- Design a standardized claims data model that can support multiple health plans and employer partners
- Map partner-specific file structures, fields, values, and definitions into Protera’s common claims structure
- Connect claims with member eligibility, attribution, enrollment, provider, and clinical data
- Maintain reusable classification logic for ICD-10, CPT, HCPCS, DRG, revenue, place-of-service, and pharmacy codes
- Document source-to-target mappings, business rules, assumptions, data lineage, and partner-specific exceptions
- Translate actuarial and medical economics requirements into scalable datasets and reporting logic
- Apply Protera’s MSK inclusion and exclusion criteria consistently across health plan populations incorporating customer service type and exclusion criteria definitions
- Ensure reported results are traceable to source data and supported by clearly documented methodologies
- Serve as a technical subject-matter expert for health plan claims and enrollment data
- Partner with Protera’s Chief Actuary to translate actuarial requirements into reliable technical solutions
- Collaborate with Protera’s data and operational teams on shared definitions for member identity, eligibility, attribution, and enrollment
- Explain complex claims methodologies and findings clearly to technical and nontechnical stakeholders
- Support the evaluation of claims data requirements for current and prospective health plan partnerships
Skills
- • 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 integrating claims with member eligibility, attribution, and enrollment data
- • Knowledge of healthcare coding systems, including ICD-10, CPT, HCPCS, DRG, revenue, place-of-service, and pharmacy codes
- • Experience with BigQuery, Google Cloud Platform, Cloud Storage, PostgreSQL, and Terraform
- • Advanced SQL skills
- • Experience designing and validating analytical data models for large healthcare datasets
- • Ability to translate actuarial, financial, and reporting requirements into production-ready technical solutions
- • Strong judgment, organization, communication, and problem-solving skills
- • Comfortable working independently in a fast-moving environment where priorities and responsibilities evolve
- • Hands-on, accountable, collaborative, and willing to personally investigate and resolve data problems
- • Fully remote, requiring a private, professional workspace and reliable high-speed internet
- • Occasional travel may be required for company or project meetings
- • Must be located in and authorized to work in the United States
- • Experience with musculoskeletal, orthopedic, rehabilitation, or pain-related claims analysis
- • Experience developing episodes-of-care methodologies
- • Experience supporting shared-savings, case-rate, bundled-payment, or full-risk contracts
- • Background in digital health, healthcare analytics, or a risk-bearing provider organization
Benefits
- Fully remote work from home or another private, secured location
- Work directly with experienced actuarial, clinical, operational, and technology leaders
Company Overview