Greenpeakstaffing
Claims Mapping & Data Flow Specialist
Greenpeakstaffing, Denver, Colorado, United States, 80285
Job Title:
Claims Mapping & Data Flow Specialist (Remote US Only)
Confidential Client Healthcare Data Technology
No third party candidates please
We value the time and privacy of every candidate who applies. To make sure real people don't get lost in the process, we use a structured hiring process that helps qualified applicants receive the attention they deserve. This includes several steps, with an in-person, skill-based interview as the final stage.
Position Overview We’re looking for a highly skilled Senior Claims Integration Specialist to take the lead on complex healthcare claims data workflows across a variety of partners and internal systems. This person will own the lifecycle of incoming claims files from onboarding new data sources, to shaping transformation logic, to solving tricky data anomalies that impact downstream reporting.
This role blends hands‑on technical work (SQL, mapping, validation, troubleshooting) with collaborative cross‑team engagement. You'll partner closely with engineering, product, analytics, and external data providers to maintain clean, reliable, and scalable claims ingestion pipelines. The ideal candidate is a problem‑solver who can translate messy real‑world data into predictable, accurate structures and enjoys building repeatable processes around it.
This is a fully remote position for US‑based applicants.
Key Responsibilities Carrier & Partner Enablement
Serve as the main technical contact for new and existing data‑exchange partners.
Clarify file specifications, formatting expectations, and integration requirements.
Lead onboarding activities for new claim sources, ensuring smooth transition into production workflows.
Claims Ingestion, Mapping & Troubleshooting
Assess inbound claims files for data quality, formatting issues, and schema alignment.
Use SQL and transformation logic to investigate discrepancies, pinpoint root causes, and correct anomalies.
Map partner‑specific fields into a unified internal data model.
Support ingestion pipeline monitoring and troubleshoot failures, delays, or unexpected patterns.
Maintain detailed documentation on business rules, validation steps, and mapping logic.
System Integration & Internal Support
Ensure processed claims data reaches all relevant internal systems and applications accurately.
Collaborate with product, engineering, and operations teams on enhancements, new use cases, and troubleshooting.
Provide guidance and clarity on how claims data flows through internal platforms.
Governance, Quality & Analysis
Establish and maintain validation routines, reconciliation checks, and QA workflows.
Track ingestion performance and proactively resolve inconsistencies or lagging files.
Investigate data discrepancies with a structured, analytical approach.
Contribute to ongoing efforts to improve data integrity, scalability, and process automation.
Required Skills & Capabilities
Strong SQL proficiency, including writing and tuning complex queries against large datasets.
Deep understanding of healthcare claims data structures and ingestion workflows.
Ability to design and refine data models supporting scalable claims integration.
Skilled at normalizing varied file formats into enterprise‑aligned schemas.
Experience collaborating across engineering, analytics, product, and external partners.
Clear, structured communicator with the ability to explain technical concepts to mixed audiences.
Preferred Qualifications
Familiarity with industry standards such as EDI (including 837), HL7, FHIR, NCPDP, and related coding systems (ICD / CPT / DRG).
Experience with claims reconciliation, data migration, or large‑scale ingestion programs.
Exposure to enterprise data platforms, ETL tools, or cloud data environments.
Knowledge of data governance, MDM, and quality frameworks.
Background in analytics‑driven organizations or data consulting environments.
Education & Experience
Bachelors or Masters in Health Informatics, Information Systems, Data / Information Science, or a similar discipline preferred.
3+ years working with healthcare claims data, integrations, or payer‑provider data exchange.
Demonstrated success managing technical relationships with external partners.
Solid communication, documentation, and problem‑solving skills.
Work Environment
Remote role requiring regular computer‑based work.
Must be able to communicate clearly in virtual settings and collaborate effectively across distributed teams.
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Claims Mapping & Data Flow Specialist (Remote US Only)
Confidential Client Healthcare Data Technology
No third party candidates please
We value the time and privacy of every candidate who applies. To make sure real people don't get lost in the process, we use a structured hiring process that helps qualified applicants receive the attention they deserve. This includes several steps, with an in-person, skill-based interview as the final stage.
Position Overview We’re looking for a highly skilled Senior Claims Integration Specialist to take the lead on complex healthcare claims data workflows across a variety of partners and internal systems. This person will own the lifecycle of incoming claims files from onboarding new data sources, to shaping transformation logic, to solving tricky data anomalies that impact downstream reporting.
This role blends hands‑on technical work (SQL, mapping, validation, troubleshooting) with collaborative cross‑team engagement. You'll partner closely with engineering, product, analytics, and external data providers to maintain clean, reliable, and scalable claims ingestion pipelines. The ideal candidate is a problem‑solver who can translate messy real‑world data into predictable, accurate structures and enjoys building repeatable processes around it.
This is a fully remote position for US‑based applicants.
Key Responsibilities Carrier & Partner Enablement
Serve as the main technical contact for new and existing data‑exchange partners.
Clarify file specifications, formatting expectations, and integration requirements.
Lead onboarding activities for new claim sources, ensuring smooth transition into production workflows.
Claims Ingestion, Mapping & Troubleshooting
Assess inbound claims files for data quality, formatting issues, and schema alignment.
Use SQL and transformation logic to investigate discrepancies, pinpoint root causes, and correct anomalies.
Map partner‑specific fields into a unified internal data model.
Support ingestion pipeline monitoring and troubleshoot failures, delays, or unexpected patterns.
Maintain detailed documentation on business rules, validation steps, and mapping logic.
System Integration & Internal Support
Ensure processed claims data reaches all relevant internal systems and applications accurately.
Collaborate with product, engineering, and operations teams on enhancements, new use cases, and troubleshooting.
Provide guidance and clarity on how claims data flows through internal platforms.
Governance, Quality & Analysis
Establish and maintain validation routines, reconciliation checks, and QA workflows.
Track ingestion performance and proactively resolve inconsistencies or lagging files.
Investigate data discrepancies with a structured, analytical approach.
Contribute to ongoing efforts to improve data integrity, scalability, and process automation.
Required Skills & Capabilities
Strong SQL proficiency, including writing and tuning complex queries against large datasets.
Deep understanding of healthcare claims data structures and ingestion workflows.
Ability to design and refine data models supporting scalable claims integration.
Skilled at normalizing varied file formats into enterprise‑aligned schemas.
Experience collaborating across engineering, analytics, product, and external partners.
Clear, structured communicator with the ability to explain technical concepts to mixed audiences.
Preferred Qualifications
Familiarity with industry standards such as EDI (including 837), HL7, FHIR, NCPDP, and related coding systems (ICD / CPT / DRG).
Experience with claims reconciliation, data migration, or large‑scale ingestion programs.
Exposure to enterprise data platforms, ETL tools, or cloud data environments.
Knowledge of data governance, MDM, and quality frameworks.
Background in analytics‑driven organizations or data consulting environments.
Education & Experience
Bachelors or Masters in Health Informatics, Information Systems, Data / Information Science, or a similar discipline preferred.
3+ years working with healthcare claims data, integrations, or payer‑provider data exchange.
Demonstrated success managing technical relationships with external partners.
Solid communication, documentation, and problem‑solving skills.
Work Environment
Remote role requiring regular computer‑based work.
Must be able to communicate clearly in virtual settings and collaborate effectively across distributed teams.
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