Overview

Lead and manage end-to-end data conversion of healthcare payer data between platforms (e.g., legacy system to HealthRules Payer / GuidingCare). Serve as subject matter expert for payer data domains — Claims, Enrollment, Provider, and Authorizations — including data structures, relationships, and business rules.

Analyze healthcare payer data patterns, perform data profiling, and define transformation and mapping rules required to migrate data from source to target platform. Design and execute a phased conversion plan covering mock runs, parallel runs, and full-volume loads, setting realistic timelines and client expectations.

Lead workflow and gap analysis sessions; identify data discrepancies and define resolution strategies. Write, maintain, and unit-test data conversion code (Python, SQL) based on documented transformation logic of limited to moderate complexity.

Design ETL processes including data extracts, load logic, stored procedures, workflows, and data mappings. Enforce naming standards and maintain data dictionaries and documentation for all conversion data models.

Handle post-installation testing; identify and correct any conversion defects prior to go-live. Plan and conduct client and user review sessions on conversion results; implement corrections based on feedback.

Maintain consistent communication with the client on conversion progress, risks, and issue resolution. Develop comprehensive documentation for all data conversions — transformation rules, mapping specs, profiling findings, and validation reports.

Collaborate with project managers, business teams, and cross-functional stakeholders across onshore and offshore teams. Mentor and guide junior team members on conversion processes, best practices, and technical standards. Develop and contribute to reusable conversion assets, accelerators, and knowledge repositories.

Required:

• 12+ years of relevant experience in technology integrations, with 7+ years in technical leadership roles.
• Hands-on experience leading data conversion or data migration projects — including mock, parallel, and full-volume execution phases.
• Deep experience with Healthcare Payer data domains: Claims (adjudication, MSP/COB, accumulators), Enrollment (member/beneficiary, eligibility), Provider, and Authorizations.
• Experience architecting software or data solutions and applying architecture governance principles.
• Strong ETL design and implementation experience across extract, transform, and load phases.
• Experience with SQL for data extraction, validation, transformation, and profiling (SQL Server required; MySQL a plus).
• Experience working in an onshore/offshore delivery model.
• Bachelor's degree or higher in a Business or Technical field.

Skill Set:

• Data conversion and migration — end-to-end delivery from profiling and mapping through mock, parallel, and full-volume runs.
• ETL design — data extracts, load logic, workflows, stored procedures, and mapping specifications.
• SQL — data profiling, validation queries, transformation logic, and post-load verification.
• Python — ETL scripting, bulk data loading, automation of conversion routines.
• Healthcare payer domain knowledge — Claims (837P/I), Enrollment (834), Provider structures, Auth rules, Accumulator logic.
• Data profiling and analysis — identifying patterns, anomalies, and gaps in source data.
• Defining transformation and mapping rules — source-to-target field-level mapping, business rule translation.
• Documentation — conversion specs, data dictionaries, mapping documents, validation reports.
• Communication — ability to present conversion status, risks, and results clearly to clients and senior management.
• Team leadership — managing and mentoring onshore/offshore technical resources.
• Analytical and problem-solving skills — troubleshooting complex data issues during conversion and POC phases.

Preferred:

• Experience with HealthRules Payer (HRP) or similar platforms.
• Medicare and/or Medicaid program experience, including CMS data structures and compliance requirements.
• Experience with EDI transaction processing — 837P, 837I (claims), and 834 (enrollment).
• Experience with ETL tools such as Informatica, Talend, or equivalent platforms.
• Experience with BI or reporting tools such as MicroStrategy, Power BI, or equivalent.
• Cloud platform exposure — AWS, Azure, or GCP; Architect or Big Data certification a plus.
• Hadoop or large-scale distributed data processing experience (MapReduce, Hive, Pig).
• Knowledge of data visualization tools and dashboard design.
• Familiarity with backup, archival, and data recovery specifications.

Geographic Responsibility:

Remote, US

Type of Employment:

Full-time, permanent

FLSA Classification (USA Only):

Exempt

Work Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

#LI-Remote

The annual US base salary range for this position is $150,000 to $170,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.