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IG
Insight Global
Remote Senior Encounter & Risk Adjustment Engineer
Career Insights for Risk Engineer
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What they do
A Risk Engineer is responsible for identifying, analyzing and minimizing risks often associated with construction or resource extraction projects. May work for insurance companies, or engineering firms.
$135,840 / year median in the U.S.
Job Description
Post Date Jun 08, 2026 Location Newtown,
Pennsylvania ZIP/Postal Code 19073 Job Type Contract-to-perm Category Programmer / Developer Req # PHL-c29042a6-e3eb-41ef-af7f-f1da102f91fb Pay Rate $53
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- $66 (hourly estimate)
JOB DESCRIPTION
We are seeking a Senior Healthcare Data Integration Engineer to work on the Exchange Encounter & Risk Adjustment team. This person will support healthcare payer operations focused on ACA Exchange Risk Adjustment, CMS EDGE submissions, encounter data quality, and healthcare data integration. This is a hands-on technical leadership role responsible for troubleshooting complex healthcare data issues, improving encounter data quality, supportingCMS EDGE
processes, and partnering across business, IT, data, and vendor teams. This is not a project management role.- Lead technical troubleshooting of encounter and risk adjustment data issues
- Analyze
CMS EDGE
submission errors and drive resolution- Support encounter reconciliation, validation, and error remediation activities
- Partner with business, operations, data, IT, and vendor teams
- Improve encounter acceptance rates and overall data quality
- Translate CMS and business requirements into technical solutions
- Provide technical guidance to developers and analysts We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.
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Insight Global's Workforce Privacy Policy:
https://insightglobal.com/workforce-privacy-policy/.REQUIRED SKILLS & EXPERIENCE
- Strong experience with SSIS, ETL, and C#
- Healthcare background, specifically with CMS/Medicare/Medicaid
- Strong understanding of healthcare payer data, including: o Claims o Encounters o Enrollment o Diagnosis data
- Advanced SQL skills for data analysis, validation, and troubleshooting
- Experience with healthcare EDI transactions
- Experience with healthcare integration platforms such as: o Edifecs o IBM ITX (Transformation Extender) o Similar healthcare EDI/integration tools
- Proven ability to troubleshoot complex healthcare data pipelines and submission issues
NICE TO HAVE SKILLS & EXPERIENCE
- HHS-HCC Risk Adjustment experience
- Direct experience supporting ACA Exchange Risk Adjustment
- Hands-on experience with
CMS EDGE
Server submissions, reconciliation, validation, and error remediation- Encounter acceptance/rejection analysis
- CMS audit support
- Data quality improvement initiatives
- Healthcare data warehouse or data lake environments
- Databricks or cloud-based healthcare data platforms
- Technical leadership or mentoring experience
- Vendor management experience Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching.