Seeking a skilled Custom Software Engineer to design, code, and enhance software components. This role involves utilizing modern frameworks and agile methodologies to deliver scalable, high-performance solutions for specific business requirements. The position also requires expertise as a Claims/Data Specialist, bridging business and technology for healthcare claims and EDI integrations to ensure data accuracy, compliance, and integrity within payer operations.

Develop custom software solutions, design code, and enhance components across various systems. Implement modern frameworks and agile practices to deliver scalable, high-performing solutions. Perform business analysis tasks including requirements elicitation, user story creation, process mapping, gap analysis, and UAT support within Agile ceremonies. Manage the end-to-end lifecycle of claims, including intake, adjudication, COB, pricing, payment, and appeals. Work with EDI standards such as 837P/I/D, 835, 277, 999, TA1, 270/271, 276/277, 278, and 834. Conduct various QA and testing activities, including functional, integration, end-to-end, data validation, regression, and UAT. Utilize SQL-based profiling and reconciliation for data analysis, identifying root causes across claims systems and EDI gateways. Log, triage, and manage defects through to closure, supporting release readiness and production validation.

A minimum of 3 years of experience in software engineering is required, with a focus on Business Process Analysis. An additional 5 years of experience is needed for Claims/Data Specialist roles. Candidates must possess a strong understanding of U.S. Payer operations, Claims adjudication, HIPAA EDI, ICD-10, CPT, HCPCS, and DRG. Technical proficiency with Advanced SQL, EDI parsing, API testing tools like Postman/SoapUI, JSON/XML, and data mapping is essential. Experience with tools such as JIRA, Azure DevOps, q.Test, SQL Server, Snowflake, Databricks, and Power BI is expected. A 15-year full-time education is a mandatory requirement. Experience with Facets, QNXT, HealthRules, Edifecs, TriZetto, FHIR/HL7, ISTQB, CBAP, or CSM is preferred.