Data Engineer, Healthcare Claims (US Based)

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

Requirements:

• • 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