Pega Smart Claims

2 days ago

Hyderabad, India Religent Systems Full time

Key Responsibilities

  • Design, develop, and implement solutions on Pega Smart Claims platform for insurance/healthcare domain.
  • Configure and customize Pega rules, flows, case types, data pages, activities, decision tables, and integrations.
  • Work closely with business stakeholders to gather requirements and translate them into functional and technical solutions.
  • Enhance and optimize claims processing workflows to improve accuracy and reduce turnaround time.
  • Perform unit testing, debugging, and defect resolution for Pega Smart Claims applications.
  • Collaborate with cross-functional teams (QA, Business Analysts, Architects) to deliver high-quality solutions.
  • Provide production support and resolve issues within SLAs.
  • Ensure compliance with Pega best practices and coding standards.

Required Skills

  • Minimum 5 years of hands-on experience in Pega PRPC with focus on Smart Claims (Healthcare/Insurance domain preferred).
  • Strong knowledge of Pega Case Management, BPM concepts, and Claims processing workflows.
  • Experience with integrations (SOAP/REST APIs, MQ, Web Services).
  • Good understanding of claims adjudication, provider/member data, and insurance domain processes.
  • Knowledge of Pega Guardrails, Ruleset Management, and Application Lifecycle Management (ALM).
  • Familiarity with Agile methodology and DevOps tools for CI/CD in Pega projects.

Good to Have

  • Pega certification such as CSA (Certified System Architect) or CSSA (Certified Senior System Architect).

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